197607628-7-16-2024-28-AS-RORN-D7GPUE-20240724113724

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197607628
Report Date: 07/16/2024
Date Signed: 07/16/2024 02:43:25 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
07/08/2024 and conducted by Evaluator Luis Mora

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20240708142211

FACILITY NAME:	PILGRIM PLACE IN CLAREMONT		FACILITY NUMBER:	197607628
ADMINISTRATOR:	RICHARD RODAS		FACILITY TYPE:	741
ADDRESS:	625 MAYFLOWER ROAD		TELEPHONE:	(909) 399-5500
CITY:	CLAREMONT	STATE: CA	ZIP CODE:	91711
CAPACITY:	454	CENSUS: 54	DATE:	07/16/2024
		UNANNOUNCED	TIME BEGAN:	08:29 AM
MET WITH:	Dawnyell Varela - Director of Assisted Living		TIME COMPLETED:	02:58 PM

ALLEGATION(S):

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Facility kitchen is not kept free from rats and other vermin.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Luis Mora conducted an unannounced initial complaint visit to determine the validity of the above-mentioned allegation. LPA met with Dawnyell Varela (Director of Assisted Living) and explained the reason for the visit.

The investigatiion consisted of the following: LPA Mora requested for copies of the staff and resident rosters, and interviewed the Director of Assisted Living, Staff 1 - Staff 13 (S1 - S13), and Resident 1 - Resident 5 (R1 - R5). LPA toured the Abernathy kitchen, skilled nursing kitchen and the assisted living kitchen. LPA reviewed pest control service logs dating back to May 2024.

Regarding the allegation "facility kitchen is not kept free from rats and other vermin", it is alleged that there is a rat infestation in the Abernathy kitchen. Director of Assisted Living stated that to her knowledge there is no rat infestation. She also stated that Abernathy kitchen is part of the independent living section, but all food for assisted living and memory care is cooked either at the Abernathy kitchen or in the skilled nursing kitchen. (Continued to LIC 9099-C)

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Wei Siew Ho	TELEPHONE: (323) 981-3969
LICENSING EVALUATOR NAME: Luis Mora	TELEPHONE: 323-981-3964
LICENSING EVALUATOR SIGNATURE:	DATE: 07/16/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/16/2024

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-20240708142211

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: PILGRIM PLACE IN CLAREMONT	FACILITY NUMBER: 197607628
	VISIT DATE: 07/16/2024

NARRATIVE

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The assisted living kitchen is too small and this is why they use the other two kitchens to cook the food and the food is transported to the assisted living kitchen in hot boxes to serve the assisted living residents. LPA interviewed 6 staff working in the Abernathy kitchen, 4 staff working in the skilled nursing kitchen, and 2 staff working in the assisted living kitchen, and they all denied the allegation. LPA also interviewed a staff from Building and Grounds whom stated that Commercial Quality Pest Control comes every Monday to provide preventive measure services throughout the entire property and there has been no reports of a rat infestation. LPA reviewed the pest control service logs dating back to May 2024 and there is no report stating that there is a rat infestation. Residents interviewed could not corroborate the allegation. LPA toured all 3 kitchens on the property and did not observe any rats or rat droppings.

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

Exit interview held and a copy of the report was provided

SUPERVISOR'S NAME: Wei Siew Ho	TELEPHONE: (323) 981-3969
LICENSING EVALUATOR NAME: Luis Mora	TELEPHONE: 323-981-3964
LICENSING EVALUATOR SIGNATURE:	DATE: 07/16/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/16/2024

LIC9099 (FAS) - (06/04)

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