197603952-3-4-2024-28-AS-RORN-D3BL7Y-20240313083105

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197603952
Report Date: 03/04/2024
Date Signed: 03/04/2024 11:53:07 AM

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
02/26/2024 and conducted by Evaluator Mary G Flores

COMPLAINT CONTROL NUMBER: 28-AS-20240226102810

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: 50	DATE:	03/04/2024
		UNANNOUNCED	TIME BEGAN:	08:34 AM
MET WITH:	Lydia Pabion - Administrator		TIME COMPLETED:	12:15 PM

ALLEGATION(S):

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Illegal eviction

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Mary Flores conducted an unannounced complaint investigation visit regarding the above allegation. LPA met with Lydia Pabion and explain the reason of the visit.

The investigation consisted of the following: LPA requested copies of staff/resident roster, reviewed resident #1’s file, and requested copies of identification and emergency sheet, physician’s report, admission agreement, notice to pay rent, receipts for payment from January 2023 – February 2024, to the facility. LPA interviewed 5 residents and 5 staff.

The investigation revealed the following: Regarding allegation Illegal eviction it is alleged R1 was given an eviction notice on 2/23/24, for lack of rent payment, per complainant R1 has paid the rent in full every month. Interviews conducted with administrator and licensee revealed R1 has not been given an eviction notice yet. (CONTINUED ON LIC 9099C)

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Tony Vasallo	TELEPHONE: (818) 419-8131
LICENSING EVALUATOR NAME: Mary G Flores	TELEPHONE: (323) 981-3965
LICENSING EVALUATOR SIGNATURE:	DATE: 03/04/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/04/2024

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-20240226102810

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: 03/04/2024

NARRATIVE

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He was provided a notice to pay to encourage resident to pay the balance due and have been waiting for R1 to make arrangements before providing R1 with a 30-day notice. Per administrator R1 pays $450 per month which is not the full amount due to the facility for the monthly rent and R1 has been reminded verbally of the amount due. Interviews with residents revealed residents were cleared of the amount due at the time of admission and the increase rate yearly on the addendum provided by the administrator. Staff interviewed stated that residents have not complaint about facility given them an illegal eviction. Documents review revealed a notice to pay rent in three days or quit in thirty days was given to R1 on 2/22/24 for the total amount due of $12,573.98 due from Jan. 1st, 2023 to Feb. 1st, 2024. Per addendum provided on 1/1/23 the monthly rate for 2023 was at $1344.82 and the addendum dated 1/1/24 monthly rate of $1418.07 per the state rate. LPA reviewed receipts of payment collected for the amount of $450 a month from 1/3/23 – 1/3/24 and $550 for 2/2/24, form of payment was noted as cash for a total of $6,400.00. Although the facility did requested payment for due balance, the facility has not provided an eviction notice at this time. Therefore, the allegation is unsubstantiated.

Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegation is UNSUBSTANTIATED.

Exit interview was conducted with Lydia Pabion and a copy of this report was provided.

SUPERVISOR'S NAME: Tony Vasallo	TELEPHONE: (818) 419-8131
LICENSING EVALUATOR NAME: Mary G Flores	TELEPHONE: (323) 981-3965
LICENSING EVALUATOR SIGNATURE:	DATE: 03/04/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/04/2024

LIC9099 (FAS) - (06/04)

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