197607628-10-19-2023-28-AS-RORN-CX7NYD-20231102105234

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197607628
Report Date: 10/19/2023
Date Signed: 10/19/2023 04:03:10 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
07/24/2023 and conducted by Evaluator Alberto Lopez

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20230724144559

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: 55	DATE:	10/19/2023
		UNANNOUNCED	TIME BEGAN:	10:17 AM
MET WITH:	Dawnyell Varela, Director of Assisted Living		TIME COMPLETED:	04:16 PM

ALLEGATION(S):

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Staff do not respond to residents' requests for assistance in a timely manner.
Staff members are under the influence of drugs while providing care.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Alberto Lopez made a subsequent unannounced visit at the facility for the purpose of completing the investigation regarding the above-mentioned allegations. During today's visit, LPA Lopez met with Director of Assisted Living, Dawnyell Varela, and explained the purpose for the visit.

On 8/03/23, LPA Lopez conducted an initial complaint visit to the facility and met with Director of Assisted Living Dawnyell Varela. The visit consisted of the following: LPA obtained a copy of the resident and staff rosters, and interviewed Staff #1 and #2 (S1, S2)

During today's visit, LPA Lopez conducted interviews with 4 Staff#3-#6 (S3-S6) and six Residents #1-#6 (R1-R6) and six witnesses W#1-W#6 (W1-W6) including family members of residents. LPA toured Pitzer Lodge South and inspected six random rooms.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Lisa Hicks	TELEPHONE: (323) 981-3972
LICENSING EVALUATOR NAME: Alberto Lopez	TELEPHONE: 323-980-4926
LICENSING EVALUATOR SIGNATURE:	DATE: 10/19/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/19/2023

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-20230724144559

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: 10/19/2023

NARRATIVE

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The investigation revealed the following.

Allegation: Staff do not respond to residents' requests for assistance in a timely manner. It is alleged that staff do not respond to calls for assistance from residents in timely manner and that staff mistreat residents.

LPA Lopez interviewed six staff members and all 6 of 6 staff members denied the allegations. LPA interviewed six residents and 6 of 6 residents could not collaborate the allegations. LPA interviewed five witnesses including family members and 6 of 6 witness could not collaborate the allegations. All 6 residents stated that they get prompt service and are never mistreated by staff. All the residents stated they are very happy living at facility. Witnesses all stated that the residents get prompt attention and are treated well. They have never heard residents raise any concerns over how long it takes staff to assist residents or how are treated. LPA tested call light response in resident’s rooms and the response time was under a minute. LPA obtained and reviewed incident reports that log in call response time from 7/30/23, 07/31/23, 08/01/23, 8/02/23, 09/30/23 and 10/01/23 – 10/18/23 and the average response time on the log was under 5 minutes. LPA did not discover any evidence to support the above allegation.

Allegation: Staff members are under the influence of drugs while providing care. It is alleged that staff are under the influence while providing care. LPA interviewed 6 staff and 6 of 6 staff denied the allegations. LPA interviewed 6 residents and 6 of 6 residents could not collaborate the allegations. Several residents expressed shock to hear the allegation. Some residents stated they would be able to tell if that was happening. LPA interviewed 6 witnesses and 6 of 6 witness could not collaborate the allegations. Several witnesses stated they have never observed staff being under the influence while visiting. Several witnesses stated they are mandated reporters and would report that if they observed any staff being under the influence while providing care. LPA did not observe any evidence of staff being under the influence during the entire visit.

Although the allegations may have happened or are valid, there is not preponderance of evidence to prove the alleged violations did or did not occur, therefore, the allegations are UNSUBSTANTIATED.

An exit interview was conducted with Director of Assisted Living and findings were discussed. A copy this report and appeal rights were provided.

SUPERVISOR'S NAME: Lisa Hicks	TELEPHONE: (323) 981-3972
LICENSING EVALUATOR NAME: Alberto Lopez	TELEPHONE: 323-980-4926
LICENSING EVALUATOR SIGNATURE:	DATE: 10/19/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/19/2023

LIC9099 (FAS) - (06/04)

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