197603952-10-19-2021-28-AS-LHIS-C8FP5K-20211104110052

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197603952
Report Date: 10/19/2021
Date Signed: 10/19/2021 04:53:43 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
11/22/2019 and conducted by Evaluator Angelica Rea

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20191122155817

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:	10/19/2021
		UNANNOUNCED	TIME BEGAN:	11:30 AM
MET WITH:	Lydia Pabion		TIME COMPLETED:	02:30 PM

ALLEGATION(S):

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Facility staff caused injury to resident.
Facility staff handles resident in a rough manner.
Facility staff threatened resident with eviction.
Facility staff failed to meet resident's needs
Food withheld from resident
Medications are not refilled in a timely manner

INVESTIGATION FINDINGS:

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

Regarding the allegation that Facility staff caused injury to resident #1 and Facility staff handle resident #1 in a rough manner, the investigation consisted of interviews with Administrator, Staff #1 - #3, and interviews with Residents #2 - #5. Administrator and Staff interviewed denied the allegation. They stated that they have not observed any staff handle residents in a rough manner, and that staff have not caused injury to any resident. Staff indicated that they have been trained on how to treat the residents. Staff interviewed stated that they were not aware that resident #1 had any bruises on her body, and denied that resident #1 was handled in a rough manner. Residents interviewed were unable to corroborate the allegation. 4 out of 4 residents stated that they have not observed staff handle resident(s) in a rough manner and have not heard of staff causing any injury to residents. Residents stated that staff treat them well. Resident #1 no longer lives at the facility, and was not interviewed.

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: 10/19/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/19/2021

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-20191122155817

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: 10/19/2021

NARRATIVE

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Regarding the allegation that Facility staff threatened resident #1 with eviction, the investigation consisted of interviews with Administrator, Staff #1 - #3, and interviews with Residents #2 - #5. Administrator and Staff interviewed denied the allegation. They stated that they did not threaten resident #1 with eviction. Residents interviewed were unable to corroborate the allegation. 4 out of 4 residents interviewed stated that they have not observed staff threaten any residents with eviction. Resident #1 no longer lives at the facility, and was not interviewed.

Regarding the allegation that Facility staff failed to meet resident #1's needs, specifically that resident #1's incontinent needs were not being met, the investigation consisted of interviews with Administrator, Staff #1 - #3, and interviews with Residents #2 - #5. Administrator and Staff interviewed denied the allegation. They stated that residents with incontinent needs are met. They stated that they order incontinence supplies in sizes to meet all of their residents needs. They denied that resident #1's incontinent needs were not met. Residents interviewed were unable to corroborate the allegation. 4 out of 4 residents interviewed stated that their needs are being met at the facility. They stated that to their knowledge the facility provides incontinence supplies to residents who need them. Resident #1 no longer lives at the facility, and was not interviewed.

Regarding the allegation that Food was withheld from a resident, the investigation consisted of interviews with Administrator, Staff #1 - #3, and interviews with Residents #2 - #5. Administrator and Staff interviewed denied the allegation. They stated that they do not withhold food from any residents. Residents interviewed were unable to corroborate the allegation. 4 out of 4 residents interviewed stated that the facility provides sufficient food to all residents and food is not withheld. Resident #1 no longer lives at the facility, and was not interviewed.

Regarding the allegation that Medications are not refilled in a timely manner, the investigation consisted of interviews with Administrator, Staff #1 - #3, and interviews with Residents #2 - #5. Administrator and Staff interviewed denied the allegation. They stated that staff order medications in a timely manner. Residents interviewed were unable to corroborate the allegation. 4 out of 4 residents interviewed stated that they have not had any problems with receiving their medications in a timely manner. Resident #1 no longer lives at the facility, and was not interviewed.

SUPERVISOR'S NAME: Lisa Hicks	TELEPHONE: (323) 981-3972
LICENSING EVALUATOR NAME: Angelica Rea	TELEPHONE: (323) 980-4929
LICENSING EVALUATOR SIGNATURE:	DATE: 10/19/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/19/2021

LIC9099 (FAS) - (06/04)

Page: 3 of 3

Control Number 28-AS-20191122155817

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: 10/19/2021

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: 10/19/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/19/2021

LIC9099 (FAS) - (06/04)

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