197603952-2-9-2024-28-AS-RORN-D4EP77-20240417110329

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197603952
Report Date: 02/09/2024
Date Signed: 02/09/2024 02:23:35 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
12/22/2023 and conducted by Evaluator Bennette Pena

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20231222091841

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: 51	DATE:	02/09/2024
		UNANNOUNCED	TIME BEGAN:	09:11 AM
MET WITH:	Lydia Pabion - Administrator		TIME COMPLETED:	02:30 PM

ALLEGATION(S):

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Staff did not provide correct medication.
Untrained staff is providing medication to residents.
Staff does not treat residents with dignity and respect.
Staff not assisting resident with needs.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Bennette Pena conducted a subsequent complaint visit to investigate the above allegations. LPA met with Lydia Pabion, Administrator and explained the reason for the visit. The initial complaint visit was conducted on 12/28/2023.

During the initial and subsequent complaint visits, the investigation consisted of the following: LPA conducted a physical plant tour of the facility, interviewed Resident #1- Resident #11 (R1- R11) and Staff #1- Staff #7 (S1- S7) altogether. LPA unable to interview Staff #8 (S8) who was not on duty. LPA also attempted to interview Resident #12 (refused to speak to LPA/on Hospice care) and Resident #13 (R13) - Resident #14 (R14) but unsuccessful as they are both non verbal. LPA obtained copies of the Resident and Staff Rosters, reviewed Residents #1-#2 (R1-R2's) file documents such as; Face Sheet, Needs and Services Plan, Physician's Report LIC 602, and Progress notes. Additionally, (5) Staff files, (3) additional Resident files (R3-R5), (5) random residents Medication Administration Records (MARs dated Oct 2023- Dec 2023), Staff In-service training logs (2022-2023) and Plan of Operation were reviewed.
*****CONTINUED ON LIC9099-C*****

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: David Sicairos	TELEPHONE: (323) 981-3982
LICENSING EVALUATOR NAME: Bennette Pena	TELEPHONE: (323) 981-3307
LICENSING EVALUATOR SIGNATURE:	DATE: 02/09/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/09/2024

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-20231222091841

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: 02/09/2024

NARRATIVE

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The investigation revealed the following:

In regards to the allegation: “Staff did not provide correct medication.” It is alleged that staff do not provide supervision when administrating medication to residents and do not provide the correct medication. No other details provided. The interviewed staff denied the allegation. S1 indicated that Caregivers are not allowed to pass medications because they do not have medication training. Staff members interviewed also indicated that they provide clients with their medications as prescribed following doctors’ orders. Other interviewed staff indicated that they received medication training as part of the educational requirements and get enough training from the Administrator to make sure that they administer the medications to the residents correctly. Interviewed residents stated that the staff never provided them with the incorrect medication. (11) of (11) residents indicated that the staff give them their medication on time and only those prescribed by their doctors. LPA reviewed (5) random residents Medication Administration Records (MARs dated Oct 2023- Dec 2023), their medications including PRNs and observed medications to be documented properly and given as prescribed. Records reviewed did not show any past or current issues regarding medication being given out to the residents incorrectly. Documentation reviewed and interviews conducted with staff and residents do not corroborate this allegation.

In regards to the allegation: “Untrained staff is providing medication to residents.” It is alleged that staff let caregivers administer medications to residents. The interviewed staff denied the allegation. S1 stated that based on their policy, only staff who have medication training are responsible for preparing and administering medications to residents. S1 indicated that none of the caregivers are allowed to pass medications because they do not have medication training. Interviewed staff indicated that only the Nurse and Med Techs are responsible to administer the medications to the residents because they have the required training. LPA reviewed (3) staff training files and their records indicated that they have all been trained in medication management, policy and procedures regarding medication, documentation, side effects and adverse reactions. Interviewed residents stated that either the Nurse or Med Techs provide them with their medications, not the caregivers. LPA did not find additional evidence that residents have been hospitalized or injured because of medication errors. Based on the information obtained, there was not enough supportive evidence to concur with the reported allegation.

SUPERVISOR'S NAME: David Sicairos	TELEPHONE: (323) 981-3982
LICENSING EVALUATOR NAME: Bennette Pena	TELEPHONE: (323) 981-3307
LICENSING EVALUATOR SIGNATURE:	DATE: 02/09/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/09/2024

LIC9099 (FAS) - (06/04)

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Control Number 28-AS-20231222091841

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: 02/09/2024

NARRATIVE

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In regards to the allegation: “Staff does not treat residents with dignity and respect.” It is alleged that staff fight with residents due to them asking for additional help and being too loud at the facility. Staff members interviewed denied the allegation. All staff interviewed indicated that they treat all residents equally and with respect. Staff indicated that they do not fight with residents due to them asking for additional help and being too loud at the facility because they understand that the residents are here because they need help. Staff also indicated that they receive training regarding residents’ personal rights. (2) out of (7) staff interviewed stated that they have heard and witnessed S2 yelled and became impatient with some residents in the past. (9) out of (11) residents interviewed denied the allegation and indicated facility staff treat them with respect and dignity. Some residents interviewed indicated that they are happy with their interactions and the services they receive from facility staff. (2) out of (11) residents stated that they have heard S2 yelled at residents sometimes. LPA reviewed the staff in-service training logs (2022-2023) indicating that the staff received training on residents’ personal rights. During the visit, LPA did not observe any staff to be disrespectful to residents. LPA also observed sufficient staff providing the services necessary to meet the residents’ needs. Therefore, there was insufficient evidence to corroborate the allegation.

In regards to the allegation: “Staff not assisting resident with needs.” It is alleged that a resident has considered committing suicide due to feeling like a burden to the facility because staff are not helping the residents with his needs. It is also alleged that another resident recently went to the hospital due to an infection that could have been caused by staff not changing the diaper as often as needed. Additionally, the resident does not want to ask for help because staff mistreat the resident. Interviewed staff denied the allegation. None of the staff interviewed heard or received a report regarding a resident being hospitalized due to an infection nor a resident committing suicide. Staff stated that they provide care and assistance to meet the residents’ needs. Staff also stated that they conduct rounds every 2-3 hours to do incontinent care or even sooner if necessary and check on residents. (10) out of (11) residents denied the allegation and stated that staff always assist them with their daily needs. None of the residents knew or heard about another resident considered committing suicide or had been sent to the hospital due to an infection. LPA reviewed R2’s files and did not find any records showing hospitalization due to infection. Therefore, there was insufficient evidence to corroborate the allegation.

Based on statements and interviews conducted with staff, residents, review of resident files and facility file records, there was not enough supportive evidence to concur with the reported allegations. 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 this report was provided to Lydia Pabion, Administrator.

SUPERVISOR'S NAME: David Sicairos	TELEPHONE: (323) 981-3982
LICENSING EVALUATOR NAME: Bennette Pena	TELEPHONE: (323) 981-3307
LICENSING EVALUATOR SIGNATURE:	DATE: 02/09/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/09/2024

LIC9099 (FAS) - (06/04)

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