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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198602243
Report Date: 04/21/2021
Date Signed: 04/22/2021 11:00:11 AM



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
10/19/2020 and conducted by Evaluator Christine Wong
PUBLIC
COMPLAINT CONTROL NUMBER: 28-AS-20201019103943
FACILITY NAME:GARFIELD TERRACE LLCFACILITY NUMBER:
198602243
ADMINISTRATOR:SANDOVAL, ROSALIEFACILITY TYPE:
740
ADDRESS:1435 N GARFIELD AVETELEPHONE:
(626) 398-0527
CITY:PASADENASTATE: CAZIP CODE:
91104
CAPACITY:60CENSUS: 35DATE:
04/21/2021
UNANNOUNCEDTIME BEGAN:
10:57 AM
MET WITH:Rosalie Sandoval -AdministratorTIME COMPLETED:
12:20 PM
ALLEGATION(S):
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Staff allows a resident to cause harm to other residents while in care
Administrator is not present for a sufficient amount of time
Staff allows resident to sleep in the hallway
Resident's room in not properly maintained
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Christine Wong conducted a subsequent complaint investigation for the allegation listed above. Due to the situation surrounding the Coronavirus Disease 2019 (COVID-19), and to implement mitigation measures, today’s complaint investigation was conducted telephonically with Administrator Rosalie Sandoval.

The investigation consisted of the following: On 10/23/20, LPA conducted a initial 10 days complaint visit and attempted to conduct virtual tour of Resident #1's room (R1) however R1 refused to allow virtual tour of the room. LPA also interviewed the Administrator and R1 on the same day. On 4/15/21, LPA interviewed additional four (4) residents and five (5) staff.

The investigation revealed of the following: Regarding allegation#1 “Staff allows a resident to cause harm to other residents while in care.”
(See LIC9099C for continuation)
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Christine YeeTELEPHONE: (323) 981-3978
LICENSING EVALUATOR NAME: Christine WongTELEPHONE: (323) 981-3963
LICENSING EVALUATOR SIGNATURE:

DATE: 04/21/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/21/2021
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 6
Control Number 28-AS-20201019103943
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: GARFIELD TERRACE LLC
FACILITY NUMBER: 198602243
VISIT DATE: 04/21/2021
NARRATIVE
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LPA interviewed four residents and three residents reported R1 was always bullied, harassed, cursed and intimidated other residents. The residents reported the staff tried to interrupt but R1 was very aggressive and no one was able to stop her. LPA interviewed five staff and four staff and reported R1 was always aggressive and argumentative to other residents. The staff reported they interfered every time R1 was being mean or cursed to other residents and even called police sometimes but R1 was very strong and continued to do it without following any instruction from staff. Based on the information obtained, the allegation is unsubstantiated.

Regarding the allegation#2 “Administrator is not present for a sufficient amount of time.” LPA interviewed four residents, and all reported that they see the administrator in the facility from Monday through Friday. LPA interviewed five staff, and all denied the allegation and reported they may not see her due to the work schedule, but the administrator does answer her calls every time if needed. LPA also attempted to contact the administrator in the facility at a different period. the administrator was able to answer calls each time when LPA called. Based on the information obtained, the allegation is unsubstantiated.

Regarding allegation#3 "Staff allows resident to sleep in the hallway.” LPA interviewed R1 and R1 reported it is her desire to sleep in the hallway because she can get more air while sleeping in the hallway. The air conditioning in her room was very unstable. LPA interviewed four residents and two residents reported R1 was sleeping in the hallway before. LPA interviewed five staff and four staff reported R1 was sleeping in the hallway for a long period of time. Staff tried to encourage R1 to go back to her room and sleep but R1’s room was full of stuff and her door was not even able to open. Administrator reported R1 is a hoarder and no staff can get into her room and assist her to clean. The administrator also brought R1 a new bed and eleven containers and assisted her to organize her room but R1 refused. Administrator also worked with R1’s case manager to find a place for R1 but R1 was refused to move. Based on the information obtained, the allegation is unsubstantiated.

Regarding the allegation#4 “Resident's room in not properly maintained.” LPA interviewed four residents, and all denied the allegation and stated resident’s room are clean and staff cleans every day and changes their linen weekly. LPA interviewed five staff and four staff stated residents’ rooms are maintained but some of the residents are more dirty than others and they cannot go to the bathroom and they do it on the bed and smelled sometimes, but staff usually would clean and change the bedsheet right away. Based on the information obtained, the allegation is unsubstantiated.
SUPERVISOR'S NAME: Christine YeeTELEPHONE: (323) 981-3978
LICENSING EVALUATOR NAME: Christine WongTELEPHONE: (323) 981-3963
LICENSING EVALUATOR SIGNATURE:

DATE: 04/21/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/21/2021
LIC9099 (FAS) - (06/04)
Page: 2 of 6
Control Number 28-AS-20201019103943
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: GARFIELD TERRACE LLC
FACILITY NUMBER: 198602243
VISIT DATE: 04/21/2021
NARRATIVE
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Based on statements and interviews conducted with residents and staff and there was not enough supportive evidence to concur with the reported allegations. Although the allegations may have happened or are valid, there are not a preponderance of evidence to prove the alleged violations did or did not occur, therefore all the allegations are UNSUBSTANTIATED.

A telephonic exit interview was conducted with Administrator Rosalie Sandoval. A hard copy of the report was emailed. Staff was instructed to sign the LIC 9099 reports and return to LPA.
SUPERVISOR'S NAME: Christine YeeTELEPHONE: (323) 981-3978
LICENSING EVALUATOR NAME: Christine WongTELEPHONE: (323) 981-3963
LICENSING EVALUATOR SIGNATURE:

DATE: 04/21/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/21/2021
LIC9099 (FAS) - (06/04)
Page: 3 of 6
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
10/19/2020 and conducted by Evaluator Christine Wong
PUBLIC
COMPLAINT CONTROL NUMBER: 28-AS-20201019103943

FACILITY NAME:GARFIELD TERRACE LLCFACILITY NUMBER:
198602243
ADMINISTRATOR:SANDOVAL, ROSALIEFACILITY TYPE:
740
ADDRESS:1435 N GARFIELD AVETELEPHONE:
(626) 398-0527
CITY:PASADENASTATE: CAZIP CODE:
91104
CAPACITY:60CENSUS: 35DATE:
04/21/2021
UNANNOUNCEDTIME BEGAN:
10:57 AM
MET WITH:Rosalie Sandoval -AdministratorTIME COMPLETED:
12:20 PM
ALLEGATION(S):
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Staff failed to keep the facility free from pests
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Christine Wong conducted a subsequent complaint investigation for the allegation listed above. Due to the situation surrounding the Coronavirus Disease 2019 (COVID-19), and to implement mitigation measures, today’s complaint investigation was conducted telephonically with Administrator Rosalie Sandoval.

The investigation consisted of the following: On 10/23/20, LPA conducted a initial 10 days complaint visit and attempted to conduct virtual tour of Resident #1's room (R1) however R1 refused to allow virtual tour of room. LPA also interviewed the Administrator and R1 on the same day. On 4/15/21, LPA interviewed additional four (4) residents and five (5) staff.

The investigation revealed of the following: In regard to the allegation “Staff failed to keep the facility free from pests. LPA interviewed four residents and two residents reported that they have seen bed bugs and roaches in the facility. (See LIC 9099C for continuation)
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Christine YeeTELEPHONE: (323) 981-3978
LICENSING EVALUATOR NAME: Christine WongTELEPHONE: (323) 981-3963
LICENSING EVALUATOR SIGNATURE:

DATE: 04/21/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/21/2021
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 4 of 6
Control Number 28-AS-20201019103943
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: GARFIELD TERRACE LLC
FACILITY NUMBER: 198602243
VISIT DATE: 04/21/2021
NARRATIVE
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They have too many bed bugs and roaches where are in the bathroom and bedroom and they were climbing on the wall and the bed. LPA interviewed five staff and four staff reported that they have seen roaches and bed bugs in the facility recently. Staff reported the roaches are huge and they were in the kitchen and by the wall and bed bugs are little bit here and there. LPA also talked to the pest control company and reported the facility does have roaches and bed bugs here and there, although it’s been stabilized, and facility does have monthly maintenance services.

Based on the interviews conducted, the preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED

California Code of Regulations, Title 22, Division 6 and Chapter 8 was cited. See LIC 9099D.

A telephonic exit interview was conducted with the Administrator Rosalie Sandoval and a hard copy was provided via email for signature.
SUPERVISOR'S NAME: Christine YeeTELEPHONE: (323) 981-3978
LICENSING EVALUATOR NAME: Christine WongTELEPHONE: (323) 981-3963
LICENSING EVALUATOR SIGNATURE:

DATE: 04/21/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/21/2021
LIC9099 (FAS) - (06/04)
Page: 5 of 6
Control Number 28-AS-20201019103943
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: GARFIELD TERRACE LLC
FACILITY NUMBER: 198602243
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/21/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
05/21/2021
Section Cited
CCR
87303(a)
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87303 Maintenance and Operation
(a) The facility shall be clean, safe, sanitary and in good repair at all times. Maintenance shall include ........residents, employees and visit
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The administrator will ensure the facility shall be clean, safe and sanitary and in good repair at all times. The administrator will contact the pest control company and initiate treatment of the facility Administrator submitted a copy of the PMC report/invoice to Licensing.
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The requirement is not met as evidenced by : Based on the interviews conducted with staff and residents and documents reviewed, the facility have roaches and bed bugs in residents room and kitchen which posed a potential Health and Safety Risk to residents in care.

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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Christine YeeTELEPHONE: (323) 981-3978
LICENSING EVALUATOR NAME: Christine WongTELEPHONE: (323) 981-3963
LICENSING EVALUATOR SIGNATURE:

DATE: 04/21/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/21/2021
LIC9099 (FAS) - (06/04)
Page: 6 of 6