198602243-10-1-2024-28-AS-RORN-DARVRG-20241106153957

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198602243
Report Date: 10/01/2024
Date Signed: 10/01/2024 12:05:20 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK ASC, 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
09/25/2024 and conducted by Evaluator Sanjay Vaid

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20240925140307

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:	10/01/2024
		UNANNOUNCED	TIME BEGAN:	09:20 AM
MET WITH:	ROSALIE SANDOVAL, ADMINISTRATOR		TIME COMPLETED:	12:30 PM

ALLEGATION(S):

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Staff are retaining residents that require a higher level of care

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Vaid conducted an unannounced subsequent complaint visit regarding the above allegation. LPA met Naylet Velasquez (Med-Aide/ Direct Staff/ Designated SUB) and explained the reason for the visit, Administrator Rosalie Sandoval arrived shortly after. Conducted physical plant tour with N Velasquez and did not observe any health and safety issues or concerns. Observed staff assisting residents. The facility is licensed to serve 60 non-ambulatory residents ages 60 and over. There is a hospice waiver approved for 5 residents. The facility currently has 3 hospice residents.

LPA Vaid requested, received, obtained and reviewed residents medical assessment/ care and service plan, physicians report for residential care facilities, copy of facility admission agreement, Hospice and palliative care plan. Staff and client rosters, staff in service training; skills and knowledge to provide necessary resident care and supervision dated 03/10/2023 and staff duties for new admitted residents dated 09/10/24.
Continued on 9099 C......

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Fernando Fierros	TELEPHONE: (323) 981-3981
LICENSING EVALUATOR NAME: Sanjay Vaid	TELEPHONE: 916-215-7924
LICENSING EVALUATOR SIGNATURE:	DATE: 10/01/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/01/2024

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-20240925140307

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK ASC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754

FACILITY NAME: GARFIELD TERRACE LLC	FACILITY NUMBER: 198602243
	VISIT DATE: 10/01/2024

NARRATIVE

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Regarding the allegation: Staff are retaining residents that require a higher level of care. It is alleged that the facility staff are not reporting health changes for certain residents that receive hospice care at the facility, the allegation further claims facility staff has not employed CNA (Certified Nurse Assistant) to assist the residents who are on hospice. The facility is an Assisted Living provider, the facility is not required to employ a Certified Nurse Assistant, as per regulations. Three (3) out of three (3) staff interviewed deny the allegation. Three (3) out of three (3) residents interviewed could not corroborate the allegation. LPA interviewed Hospice care residents. According to the physicians reports and hospice assessments, the staff caregivers and Home Health Hospice agencies are communicating residents’ health and forwarding health concerns and issues to the primary physician who determines whether higher level of care is further required. Hospice agencies assigned to the residents come three time per week to assist with showering and incontinent needs, the facility staff assists residents with other grooming and daily living needs. LPA observed home health agencies assisting other residents at the facility. LPA observed facility staff caregivers working with Hospice home care to ensure that hospice residents are comfortable with their needs and services. LPA reviewed Restricted Health Conditions/ Allowable Health Conditions folder, containing residents on hospice, special diets, treatment of healing wounds, residents using insulin, residents using ear and eyes drops, catheters and home health services received by residents and trace logged by the staff. 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.

An exit interview was conducted and copy of report was left with the Administrator.

SUPERVISOR'S NAME: Fernando Fierros	TELEPHONE: (323) 981-3981
LICENSING EVALUATOR NAME: Sanjay Vaid	TELEPHONE: 916-215-7924
LICENSING EVALUATOR SIGNATURE:	DATE: 10/01/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/01/2024

LIC9099 (FAS) - (06/04)

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