197603952-6-23-2021-28-AS-LHIS-C6XQVE-20210917123011

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197603952
Report Date: 06/23/2021
Date Signed: 06/23/2021 04:27:11 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 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
06/16/2021 and conducted by Evaluator Angelica Rea

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20210616144852

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: 45	DATE:	06/23/2021
		UNANNOUNCED	TIME BEGAN:	10:40 AM
MET WITH:	Lydia Pabion		TIME COMPLETED:	01:50 PM

ALLEGATION(S):

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Facility does not provide a safe and healthy environment for residents in care
Staff did not answer call buttons on a timely basis

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Angelica Rea and Nina Galarza conducted an unannounced complaint visit in response to the above allegations. LPA met with Administrator, Lydia Pabion who assisted with today's visit.

The investigation consisted of interview(s) with Administrator, Staff #1, Staff #2, and Resident #1-Resident #6, and tour of facility. Regarding the allegation that (1) Facility staff does not provide a safe and healthy environment for residents in care, specifically that there are homeless people loitering outside the facility. Administrator and Staff interviewed denied the allegation. They stated that they provide a safe environment for their residents. They stated that they do not have homeless people loitering outside the facility. Residents interviewed were unable to corroborate the allegation. 4 out of 6 residents interviewed stated that they have never seen a homeless person near the facility. Regarding the allegation that (2) Staff did not answer call buttons in a timely basis. Administrator and Staff interviewed denied they allegation. They stated that there is always a receptionist, or a med tech sitting at the front desk, to answer the calls. LPA's toured several rooms during todays visit, and observed the call system was operational and staff responded in a timely manner. Residents interviewed were unable to corroborate the allegation. 5 out of 6 residents stated that staff answer the call buttons in a timely manner.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Lisa Hicks	TELEPHONE: (323) 981-3972
LICENSING EVALUATOR NAME: Angelica Rea	TELEPHONE: (323) 980-4929
LICENSING EVALUATOR SIGNATURE:	DATE: 06/23/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/23/2021

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-20210616144852

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754

FACILITY NAME: PROSPECT MANOR	FACILITY NUMBER: 197603952
	VISIT DATE: 06/23/2021

NARRATIVE

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Based on LPA's observations and interviews, investigation revealed: 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.

No Deficiencies cited under California Code of Regulations Title 22. Exit interview conducted, and a copy of report was provided to Administrator, Lydia Pabion

SUPERVISOR'S NAME: Lisa Hicks	TELEPHONE: (323) 981-3972
LICENSING EVALUATOR NAME: Angelica Rea	TELEPHONE: (323) 980-4929
LICENSING EVALUATOR SIGNATURE:	DATE: 06/23/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/23/2021

LIC9099 (FAS) - (06/04)

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