198602243-3-26-2024-28-AS-TVAO-D46T8A-20240409143000

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198602243
Report Date: 03/26/2024
Date Signed: 03/26/2024 10:59:22 AM

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
03/18/2024 and conducted by Evaluator Mary G Flores

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20240318102723

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: 30	DATE:	03/26/2024
		UNANNOUNCED	TIME BEGAN:	08:45 AM
MET WITH:	Naylet Velazquez - Med Aide		TIME COMPLETED:	11:15 AM

ALLEGATION(S):

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Facility manager does not allow staff to assist a resident in care.
Facility manager confiscated resident's personal belongings.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Mary Flores conducted an unannounced complaint investigation visit regarding the above allegations. LPA met with Naylet Velazquez and explained the reason for the visit.

The investigation consisted of the following: LPA requested copies of staff/resident roster. LPA conducted interviews with 4 residents and 4 staff. LPA requested a copy of resident #1’s (R1) personal property and values form, physician’s report, admission agreement and last staff in-service on resident care and supervision. LPA conducted a tour of R1’s room.

The investigation revealed the following: Regarding allegation: Facility manager does not allow staff to assist a resident in care. It is alleged the manager does not allow the staff to assist a resident who cannot see. Interviews with residents revealed staff assist and provide care to residents as needed. Overall all staff are good with residents. Administrator ensures that residents are provided assistance in all their needs.
(CONTINUED ON LIC 9099C)

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Tony Vasallo	TELEPHONE: (818) 419-8131
LICENSING EVALUATOR NAME: Mary G Flores	TELEPHONE: (323) 981-3965
LICENSING EVALUATOR SIGNATURE:	DATE: 03/26/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/26/2024

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-20240318102723

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: GARFIELD TERRACE LLC	FACILITY NUMBER: 198602243
	VISIT DATE: 03/26/2024

NARRATIVE

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Interviews with staff revealed staff are aware that they must assist residents. Administrator has not told any of the staff to not assist a resident in need. Facility provided an in-service to staff on 3/8/24 on Resident Care and Supervision.

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

Regarding allegation: Facility manager confiscated resident's personal belongings. It is alleged that when manager has an issue with the resident confiscates the resident's personal items such as radio and tv. Interviews with residents revealed 3 out of 4 residents stated to have all their belongings and administrator will not confiscate items as retaliation. 1 out of 4 residents stated recently the room was fumigated and upon returning the TV and radio provided by case manager were gone and a new one has not been provided. Resident stated to not have issues with staff. Interviews with staff revealed facility staff/administrator have not removed any items from the residents as retaliation. All resident items are not touch. Documents review revealed R1 does not have listed a TV or radio in the personal property and valuables.

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

Exit interview was conducted with Rosalie Sandoval Administrator and a copy of this report was provided.

SUPERVISOR'S NAME: Tony Vasallo	TELEPHONE: (818) 419-8131
LICENSING EVALUATOR NAME: Mary G Flores	TELEPHONE: (323) 981-3965
LICENSING EVALUATOR SIGNATURE:	DATE: 03/26/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/26/2024

LIC9099 (FAS) - (06/04)

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