198602243-5-14-2024-28-AS-LHIS-D5SPWG-20240531114044

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198602243
Report Date: 05/14/2024
Date Signed: 05/14/2024 09:53:01 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
05/02/2024 and conducted by Evaluator Jewel Baptiste

COMPLAINT CONTROL NUMBER: 28-AS-20240502104510

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:	05/14/2024
		UNANNOUNCED	TIME BEGAN:	09:27 AM
MET WITH:	Administrator Roslie Sandoval		TIME COMPLETED:	10:07 AM

ALLEGATION(S):

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Staff threatened resident

INVESTIGATION FINDINGS:

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On 05/14/2024 at 09:27 a.m., Licensing Program Analyst (LPA) Jewel Baptiste conducted a subsequent complaint visit to investigate the above allegation. Upon arrival LPA met the Administrator Rosalie Sandoval and explained the reason for the visit.

During the initial visit LPA conducted a tour of the facility with the Administrator. LPA also interviewed the Administrator and a total of two (2) staff, who shall be referred to as Staff#1-2 (S1-S2). LPA Baptiste interviewed a total of four (4) residents, who shall be referred to as Resident #2- 5 (R2-R5). LPA interviewed Resident#1 (R1) via phone. LPA Baptiste obtained staff and resident roster and conducted file review for S1 and R1's file.

Report Continued on 9099c

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Lisa Hicks	TELEPHONE: (323) 213-1556
LICENSING EVALUATOR NAME: Jewel Baptiste	TELEPHONE: (323) 400-9594
LICENSING EVALUATOR SIGNATURE:	DATE: 05/13/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/13/2024

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 4

Control Number 28-AS-20240502104510

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: 05/14/2024

NARRATIVE

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The investigation reveals the following: Regarding “Staff threaten resident”. It is alleged that the staff threaten the residents. The Administrator denied the allegation stating they have never threatened the residents. 2 out of 2 staff denied the allegations stating they have never threatened the residents. 5 out of 5 residents denied the allegation stating staff has never threaten them or they have never witness other residents being threatened by staff.

Based on LPA's interviews, investigation revealed: Although the allegation may have happened or is valid,

there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the
allegation is UNSUBSTANTIATED.

Exit interview conducted with the Administrator Rosalie Sandoval and a copy of this record provided.

SUPERVISOR'S NAME: Lisa Hicks	TELEPHONE: (323) 213-1556
LICENSING EVALUATOR NAME: Jewel Baptiste	TELEPHONE: (323) 400-9594
LICENSING EVALUATOR SIGNATURE:	DATE: 05/14/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/14/2024

LIC9099 (FAS) - (06/04)

Page: 2 of 4

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
05/02/2024 and conducted by Evaluator Jewel Baptiste

COMPLAINT CONTROL NUMBER: 28-AS-20240502104510

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:	DATE:	05/14/2024
		UNANNOUNCED	TIME BEGAN:	09:27 AM
MET WITH:	Administrator Roslie Sandoval		TIME COMPLETED:	10:07 AM

ALLEGATION(S):

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Staff punched resident

INVESTIGATION FINDINGS:

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Unfounded

Estimated Days of Completion:

SUPERVISOR'S NAME: Lisa Hicks	TELEPHONE: (323) 213-1556
LICENSING EVALUATOR NAME: Jewel Baptiste	TELEPHONE: (323) 400-9594
LICENSING EVALUATOR SIGNATURE:	DATE: 05/14/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/14/2024

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

Page: 3 of 4

Control Number 28-AS-20240502104510

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: 05/14/2024

NARRATIVE

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The investigation reveals the following: Regarding “Staff punched resident”. It is alleged that staff#1(S1) punched resident#6(R6). The Administrator denied the allegation stating R6 is not a resident at the facility and confirmed that none of the staff have ever physically assaulted a resident. 2 out of 2 staff denied the allegations stating they have never physically assaulted the residents. 5 out of 5 residents denied the allegation stating they were never assaulted or witness other residents being assaulted by staff. LPA reviewed resident roster and observed R6 do not live at the facility. LPA also reviewed S1’s files and did not observe disciplinary actions.

Based on the information gathered during this visit, the allegation is deemed UNFOUNDED.

A finding of UNFOUNDED means that the allegation is either false, could not have happened, and/or is without a reasonable basis.

Exit interview conducted with the Administrator Rosalie Sandoval and a copy of this record provided.

SUPERVISOR'S NAME: Lisa Hicks	TELEPHONE: (323) 213-1556
LICENSING EVALUATOR NAME: Jewel Baptiste	TELEPHONE: (323) 400-9594
LICENSING EVALUATOR SIGNATURE:	DATE: 05/14/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/14/2024

LIC9099 (FAS) - (06/04)

Page: 4 of 4