198602243-5-3-2024-28-AS-LHIS-D58PFM-20240513111659

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198602243
Report Date: 05/02/2024
Date Signed: 05/03/2024 11:54:54 AM

Unsubstantiated

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
04/26/2024 and conducted by Evaluator Nicol Wesley

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20240426095643

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: 32	DATE:	05/02/2024
		UNANNOUNCED	TIME BEGAN:	10:35 AM
MET WITH:	Rosalie Sandoval		TIME COMPLETED:	03:15 PM

ALLEGATION(S):

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Facility staff takes resident's personal belongings.
Facility staff interfering with resident's right to have visitors.
Facility staff speak inappropriately to residents.
Facility staff allow resident to drink from a cup with a roach in it.
Facility staff left resident on the floor for several hours.

INVESTIGATION FINDINGS:

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Licensing Program Analyst(LPA) Nicol Wesley conducted an unannounced 10 day complaint visit at the facility and met with Executive Director Rosalie Sandoval to discuss the purpose for todays visit.

During the visit, LPA Wesley requested a copy of the staff and resident roster, observed exterminator invoices, toured random resident rooms, dining room, kitchen, interviewed the residents, interviewed the executive directtor and the staff #1. Resident #1 and Resident #2 was not present in the facilty.

Regarding allegation: Facility staff takes resident's personal belongings. LPA interviewed 6 residents who indicated that the staff does not take their personal belongings. In regards to resident #1 staff indicated that resident #1 doesn't have a TV, he is blind and the radio that he had in his room belonged to staff #1.

Continued on LIC 9099C.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Lisa Hicks	TELEPHONE: (323) 981-3972
LICENSING EVALUATOR NAME: Nicol Wesley	TELEPHONE: (323) 981-3975
LICENSING EVALUATOR SIGNATURE:	DATE: 05/02/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/02/2024

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-20240426095643

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: 05/02/2024

NARRATIVE

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Regarding allegation: Facility staff interfering with resident's right to have visitors. LPA Wesley interviewed 6 residents who indicated that the staff never interferes with their visitors if they were to visit. In regards to resident #1 he had a visitor that came to the facility drunk and aggressive towards staff and residents, they asked him to leave because he was posing a risk to residents in the RCFE, Other than that, the staff have never interfered with the residents rights to have visitors.

Regarding allegation: Facility staff speak inappropriately to residents. LPA Wesley interviewed 6 residents who said the staff does not speak to them inappropriately. LPA Wesley interviewed the staff and they said they never speak inappropriately to residents.

Regarding allegation: Facility staff allow resident to drink from a cup with a roach in it. LPA Wesley interviewed 6 residents who said they have never received food or drink with a roach in it. One resident said he have never seen a roach in the facility. The Executive director said the facility receives extermination from an outside source and from the facility maintenance person, and they have never served anyone a drink or food with a roach in it.

Regarding allegation: Facility staff left resident on the floor for several hours. LPA interviewed 6 residents who said the staff never left them unattended or on the floor for several hours. One of the residents said he is a fall risk and they have never left him unattended on the floor for several hours. In regards to resident #2 he had fallen at 3:30 am and called for staff and they came to got him off the floor. He is high functioning and can be heard if he screamed for help, resident #2 also has a cellphone and calls 911 when he needs immediate medical attention that the facility can't provide.

Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegation is UNSUBSTANTIATED. A copy of the LIC 9099, LIC 9099C was given during the exit interview.

SUPERVISOR'S NAME: Lisa Hicks	TELEPHONE: (323) 981-3972
LICENSING EVALUATOR NAME: Nicol Wesley	TELEPHONE: (323) 981-3975
LICENSING EVALUATOR SIGNATURE:	DATE: 05/02/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/02/2024

LIC9099 (FAS) - (06/04)

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