197603952-11-7-2023-28-AS-RORN-CZJMGL-20240116083608

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197603952
Report Date: 11/07/2023
Date Signed: 11/07/2023 03:03:33 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
GREATER LA AC/SC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754

This is an official report of an unannounced visit/investigation of a complaint received in our office on
10/30/2023 and conducted by Evaluator Luis Mora

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20231030095916

FACILITY NAME:	PROSPECT MANOR		FACILITY NUMBER:	197603952
ADMINISTRATOR:	LYDIA PABION		FACILITY TYPE:	740
ADDRESS:	800 PROSPECT AVE		TELEPHONE:	(626) 799-1141
CITY:	SOUTH PASADENA	STATE: CA	ZIP CODE:	91030
CAPACITY:	99	CENSUS: 53	DATE:	11/07/2023
		UNANNOUNCED	TIME BEGAN:	11:42 AM
MET WITH:	Lydia Pabion – Administrator		TIME COMPLETED:	03:17 PM

ALLEGATION(S):

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Facility has bedbugs.
Staff are sleeping at the facility.

INVESTIGATION FINDINGS:

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Licensing Program Analysts (LPAs) Mora and Vaid conducted an unannounced complaint visit regarding the above allegations. LPAs met with Lydia Pabion (Administrator) and explained the reason for the visit.

The investigation consisted of the following: LPAs obtained copies of staff and resident rosters, reviewed pest control reports dating back to June 2023, and interviewed Administrator, Staff 1 - Staff 6 (S1 - S6) and Resident 1 - Resident 7 (R1 - R7). LPAs also toured 3 resident rooms and the facility's TV room.

The investigation revealed the following: regarding the allegation "facility has bedbugs", it is alleged that there are bedbugs in rooms 201, 205, 227 and the facility's TV room. Administrator denied the allegation and stated no bedbugs complaints have been brought to her attention. Staff interviewed could not corroborate the allegations. Residents in rooms 201 and 227 denied having bedbugs and resident in room 205 was out in the community and not available for an interview. (Continued to LIC 9099-C)

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Wei Siew Ho	TELEPHONE: (323) 981-3969
LICENSING EVALUATOR NAME: Luis Mora	TELEPHONE: 323-981-3964
LICENSING EVALUATOR SIGNATURE:	DATE: 11/07/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/07/2023

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

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Control Number 28-AS-20231030095916

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
GREATER LA AC/SC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754

FACILITY NAME: PROSPECT MANOR	FACILITY NUMBER: 197603952
	VISIT DATE: 11/07/2023

NARRATIVE

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The other residents interviewed could not corroborate the allegation. During the tour, LPAs did not observed bedbugs in the facility's TV room nor in Room 201 and 227. Room 205 was locked due to resident was out in the community. LPAs also reviewed pest control reports dating back to June 2023 and all reports stated no activity was noticed.

Regarding the allegation "staff are sleeping at the facility", it is alleged that staff are sleeping at the facility during their shifts. Administrator stated 2 months ago she reviewed her camera footage and noticed a graveyard staff sleeping on job. She confronted the staff and the staff resigned on 09/14/23. Administrator stated this was a one time incident and no other staff have slept on the job. Staff interviewed could not corroborate the allegation. Residents interviewed could not corroborate the allegation.

Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are unsubstantiated.

Exit interview held and a copy of the report was provided

SUPERVISOR'S NAME: Wei Siew Ho	TELEPHONE: (323) 981-3969
LICENSING EVALUATOR NAME: Luis Mora	TELEPHONE: 323-981-3964
LICENSING EVALUATOR SIGNATURE:	DATE: 11/07/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/07/2023

LIC9099 (FAS) - (06/04)

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