198602243-5-7-2024-28-AS-TVAO-D5CUPB-20240517154513

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198602243
Report Date: 05/07/2024
Date Signed: 05/07/2024 12:36:08 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
05/03/2024 and conducted by Evaluator Mary G Flores

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20240503143132

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: 33	DATE:	05/07/2024
		UNANNOUNCED	TIME BEGAN:	08:42 AM
MET WITH:	Naylet Velazquez - Med Aide		TIME COMPLETED:	12:50 PM

ALLEGATION(S):

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Facility does not have a qualified administrator.
Facility staff failed to give resident P&I funds.
Facility administrator does not allow resident to file complaint to public agencies.
Facility staff are not properly trained.

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 a copy of staff and resident roster. LPA toured common areas, reviewed 5 staff files, and interviewed 4 staff and 5 residents. LPA requested copies of administrator’s certificate renewal documents, administrator’s personnel record, staff’s personnel records, initial training and 2022- 2023 – 20 hours of training for each staff, trust bank statement - May 2024 for P&I funds, petty cash request form for May 2024, and 5 residents record of resident’s safeguarded cash resources.

The investigation revealed the following: Regarding allegation: Facility does not have a qualified administrator. It is alleged there is not an administrator who is qualified at the facility.
(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: 05/07/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/07/2024

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-20240503143132

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: 05/07/2024

NARRATIVE

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Interview conducted with administrator revealed administrator has been in the field as an administrator since 1990. Documents reviewed revealed facility’s assigned administrator Rosalie Sandoval, has an administrator certificate #6012456740 with expiration date 1/24/24 and renewal documents were mailed out to the department on 12/14/23. Administrator’s personnel record dated 6/9/16 lists education and previous employment. Administrator meets the requirements for education and experience per Title 22 Regulations for a facility of capacity of 50 residents and over.

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 staff failed to give resident P&I funds. It is alleged most of the residents don't receive their P&I money. Interviews conducted with residents revealed 3 out of 5 residents stated to receive P&I funds once a month on the first day of the month or the Friday before the first of the month. They stated to not be denied their funds at any time. 1 out of 5 residents stated to handle own funds and 1 out of 5 residents was not able to provide an answer due to cognitive skills. Interviews conducted with staff revealed residents received P&I funds and they have not complaint that their money is being denied. Per staff there is only one resident who may state funds are not being provided. However, this resident no longer receives P&I funds due to funding source change. Facility keeps a trust bank account in which P&I funds for the residents, a balance was observed. A check request form was observed for the facility for the month of May 2024 with petty cash provided to the facility for the amount of $4000.00 from which P&I funds were provided to the residents. Each resident who receives P&I funds has a safeguarded cash resources form and the amounts withdrawn and balance is noted in each form with staff and residents' signatures.

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 administrator does not allow resident to file complaint to public agencies. It is alleged “executive director is untouchable, so no one can complaint to the Licensing and Ombudsman” agencies. LPA toured the common areas and observed Complaint Hotline for Department of Social Service poster posted outside the medication room and Local Ombudsman poster in the hallway across the dining room and in the entrance of the facility. (CONTINUED ON LIC 9099C)

SUPERVISOR'S NAME: Tony Vasallo	TELEPHONE: (818) 419-8131
LICENSING EVALUATOR NAME: Mary G Flores	TELEPHONE: (323) 981-3965
LICENSING EVALUATOR SIGNATURE:	DATE: 05/07/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/07/2024

LIC9099 (FAS) - (06/04)

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Control Number 28-AS-20240503143132

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: 05/07/2024

NARRATIVE

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Interviews conducted with residents revealed 3 out of 5 residents are aware of the name of the agencies to call to complaint 2 out of the 3 residents are aware were to find the phone numbers. 1 out of 5 residents was not aware of the complaint phone numbers or agencies to complaint and 1 out of 5 residents was unable to answer due to cognitive skills. Interviews with staff revealed residents know were to complaint and the staff point to the posters when they inquire about where to complaint.

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 staff are not properly trained. It is alleged that staff are not trained properly to meet the needs of the residents. Interviews conducted with residents revealed 3 out of 5 residents feel staff are knowledgeable of their responsibilities. 2 out of 5 residents were unable to provide an answer due to cognitive skills. Interviews with staff revealed staff received training consistently throughout the year, each training provided is for an hour, and staff received initial training when hired. Documents reviewed reveal staff have received 40 hours of initial training and 20 hours of training on Documentation, Monitoring Residents, Emergency Procedures, Incident Reports, Medical Emergencies, Personal Care, Personal Rights, Medications, Hospice, Dementia, Activities of Daily Living, Recreation, End of Life Care, Food Services, Basic Care, Resident Care and Supervision. Personnel Record for each staff list staff’s education and experience and each staff is over 18 years old.

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 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: 05/07/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/07/2024

LIC9099 (FAS) - (06/04)

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