198602243-7-28-2022-28-AS-MVAO-CJ2UCF-20220907152752

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198602243
Report Date: 07/28/2022
Date Signed: 07/28/2022 01:07:06 PM

Substantiated

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
07/25/2022 and conducted by Evaluator Noemi Galarza

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20220725123540

FACILITY NAME:	GARFIELD TERRACE LLC		FACILITY NUMBER:	198602243
ADMINISTRATOR:	SANDOVAL, ROSALIE		FACILITY TYPE:	740
ADDRESS:	1435 N GARFIELD AVE		TELEPHONE:	(626) 398-0527
CITY:	PASADENA	STATE: CA	ZIP CODE:	91104
CAPACITY:	60	CENSUS: 28	DATE:	07/28/2022
		UNANNOUNCED	TIME BEGAN:	09:20 AM
MET WITH:	Naylet Velasquez, Staff		TIME COMPLETED:	01:10 PM

ALLEGATION(S):

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Facility is not providing safe accommodations for resident(s) in care.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Galarza conducted an initial 10-Day complaint visit to investigate the above allegation.The purpose of the visit was discussed with Medication Aide Naylet Velasquez.

The investigation consisted of: A physical plant tour of the facility, room #4, and obsevation of all facility exit doors was conducted. Residents (R1- R8) and staff (S1-S3) were interviewed. Staff (S4) was not present; therefore not interviewed. Resident (R1's) Admission Agreement, facility visitation policy, plan of operation (exterior door section), incident report (722/22), photos of exit doors, LIC 500 personnel Report, and resident roster were reviewed and obtained.

See LIC 9099C for report continuation.

Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Lisa Hicks	TELEPHONE: (323) 981-3972
LICENSING EVALUATOR NAME: Noemi Galarza	TELEPHONE: (323) 981-3974
LICENSING EVALUATOR SIGNATURE:	DATE: 07/28/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/28/2022

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-20220725123540

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: 07/28/2022

NARRATIVE

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Allegation: "Facility is not providing safe accommodations for resident(s) in care." It is alleged that on Friday, July 22, 2022 a transient woman entered the facility at approximately 9:00 pm and entered resident (R1's) room and grabbed R1's ankle. A verbal altercation ensued and the transient woman left the facility. At approximately 9:16 PM, Pasadena Police responded to the incident, but did not find the transient woman in the premises. It is suspected the transient woman entered through the rear door that residents leave unlocked at night, so they can smoke outside. According to resident interviews, the transient woman that entered the facility on 7/22/2022 frequently enters the building during evening/night time hours and juggles the resident room door to see if they are unlocked. If unlocked, the woman enters the room and steals items i.e. TV's, cell phones, blankets, and any other personal items. The woman has been observed entering the kitchen area and grabbing food. An additional incident occurred on Sunday, July 24, 2022, in which it is suspected the transient woman entered the facility again and stole resident (R8's) cell phone and a police report was filed.

A total of eight (8) residents were interviewed, all confirmed the transient woman enters the facility regularly during night shift hours. Four (4) out of eight (8) residents stated they have seen the woman take and exit the building with resident's personal belongings. All staff interviewed confirmed the transient woman has history of entering the building through the side and rear doors. Staff stated that the side and rear doors are not operating properly and must be pulled shut in order for the doors to close properly. As a result, when the doors are opened they do not close completely and they are not securely closed; which allows residents outdoors, and anyone else to enter the facility. The residents at the facility are mentally disabled and smoke outdoors at all times of the day; including night time hours. Staff (S4) was on duty during the 7/22/2022 incident. Pasadena Police were called and responded to the incident. The incident was documented on the log book. As of today, the facility had not faxed the 7/22/2022 incident report to CCL.

The physical plant inspection confirmed the side and rear doors do not close properly. Photos were taken of the exit doors. It is probable the transient woman is regularly entering the facility through the side and rear doors. Therefore, residents in care are not being provide safe accommodations.

Based on interviews conducted and observations, the preponderance of evidence standard has been met, therefore the above allegation(s) is found to be SUBSTANTIATED. Deficiency is cited. See LIC 9099D.

Exit interview was conducted with Med-Aide Naylet Velasquez. A copy of the report and appeal rights were provided.

SUPERVISOR'S NAME: Lisa Hicks	TELEPHONE: (323) 981-3972
LICENSING EVALUATOR NAME: Noemi Galarza	TELEPHONE: (323) 981-3974
LICENSING EVALUATOR SIGNATURE:	DATE: 07/28/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/28/2022

LIC9099 (FAS) - (06/04)

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Control Number 28-AS-20220725123540

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: 07/28/2022

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Request Denied Type B 08/04/2022 Section Cited CCR 87307(d)(2)	1 2 3 4 5 6 7	87307(d)(2) Personal Accommodations and Services. The following space and safety provisions shall apply to all facilities: The premises shall be maintained in a state of good repair and shall provide a safe and healthful environment. This requirement was not met evidenced by:	1 2 3 4 5 6 7	Administrator shall develop and submit a written Plan of Correction (POC) that addresses how the facility will comply and conduct staff training. ***All side and rear doors shall be repaired and/or replaced due to disrepair. Submit proof of service invoice and pictures by POC due date.
	8 9 10 11 12 13 14	Based on interviews conducted and record review on 7/22/2022 and 7/24/2022 a transient woman entered the facility through unlocked side and/or rear doors and grabbed R1's ankle, and on 7/24/2022 stole R8'scell phone; which poses a potential health and safety risk to persons in care.	8 9 10 11 12 13 14	If additional time is required to complete noted items to correct submit a written extension request prior to the due date.
CCR	1 2 3 4 5 6 7		1 2 3 4 5 6 7
	1 2 3 4 5 6 7		1 2 3 4 5 6 7

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: Lisa Hicks	TELEPHONE: (323) 981-3972
LICENSING EVALUATOR NAME: Noemi Galarza	TELEPHONE: (323) 981-3974
LICENSING EVALUATOR SIGNATURE:	DATE: 07/28/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/28/2022

LIC9099 (FAS) - (06/04)

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