197606301-8-4-2021-28-AS-WSHO-C6UK9Z-20210914074307

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197606301
Report Date: 08/04/2021
Date Signed: 08/04/2021 02:33:58 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
07/29/2021 and conducted by Evaluator Joe Katrdzhyan

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20210729090721

FACILITY NAME:	BROOKDALE MONROVIA		FACILITY NUMBER:	197606301
ADMINISTRATOR:	BALBIN, RALPH		FACILITY TYPE:	740
ADDRESS:	201 E FOOTHILL BLVD		TELEPHONE:	(626) 301-0204
CITY:	MONROVIA	STATE: CA	ZIP CODE:	91016
CAPACITY:	75	CENSUS: 60	DATE:	08/04/2021
		UNANNOUNCED	TIME BEGAN:	11:15 AM
MET WITH:	Administrator /		TIME COMPLETED:	02:45 PM

ALLEGATION(S):

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Resident mistreated by staff

Facility staff did not safeguard resident's personal property

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Joe Katrdzhyan conducted an unannounced 10 day complaint visit to this facility. Upon arriving at the facility, LPA met with Executive Director / Alison Pastores who assisted with the visit. LPA explained the purpose of today’s visit is to discuss the above mentioned allegations of "Resident mistreated by staff" and "Facility staff did not safeguard resident's personal property".

During today's visit, LPA interviewed Resident #1 (R1), Staff #1 (S1) and former Executive Director / Ralph Balbin (via telephone).

The investigation revealed the following;
Allegation: Resident mistreated by staff. The details of this allegation states that R1 is sickened by how he was treated, and cries at night because of the treatment he received from former Executive Director / Ralph Balbin.
During the interview with R1, R1 denied being abused by any staff members. The allegation of R1 being

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Wei Siew Ho	TELEPHONE: (323) 981-3969
LICENSING EVALUATOR NAME: Joe Katrdzhyan	TELEPHONE: (323) 981-3968
LICENSING EVALUATOR SIGNATURE:	DATE: 08/04/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/04/2021

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-20210729090721

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: BROOKDALE MONROVIA	FACILITY NUMBER: 197606301
	VISIT DATE: 08/04/2021

NARRATIVE

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mistreated and crying at night is in reference to former Executive Director / Ralph Balbin not keeping his promise by reimbursing the alleged missing money to R1. During the interview with former Executive Director / Ralph Balbin, LPA learned that there was never a written agreement created between the Facility and R1 and no promises were made indicating that the Facility would be responsible for refunding R1 for the missing money. Former Executive Director stated that Facility agreed to provide R1 with half of the missing money ($350.00) in the form of rent credit as a measure of good faith but facility was not admitting guilt in doing so. On 6/5/19 and 6/6/19, R1 received a total of $350 in rent credit. Facility conducted an internal investigation and cooperated with law enforcement in hopes of finding R1's missing money, but efforts were unsuccessful. Based on interviews conducted, there is insufficient evidence to support the allegation of "Resident mistreated by staff".

Allegation: Facility staff did not safeguard resident's personal property. This allegation was already investigated and addressed by LPA David Sicairos on 11/21/2019 on Complaint #28-AS-20190924174431. The findings were delivered as Unsubstantiated. Please refer to Complaint #28-AS-20190924174431 for additional information.

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.

An exit interview was conducted and a copy of this report was provided to the Executive Director.

SUPERVISOR'S NAME: Wei Siew Ho	TELEPHONE: (323) 981-3969
LICENSING EVALUATOR NAME: Joe Katrdzhyan	TELEPHONE: (323) 981-3968
LICENSING EVALUATOR SIGNATURE:	DATE: 08/04/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/04/2021

LIC9099 (FAS) - (06/04)

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