198602243-3-11-2025-28-AS-RORN-DEQQ57-20250313115124

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198602243
Report Date: 03/11/2025
Date Signed: 03/11/2025 03:59:55 PM

Unfounded

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
03/04/2025 and conducted by Evaluator Sanjay Vaid

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20250304112323

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: 35	DATE:	03/11/2025
		UNANNOUNCED	TIME BEGAN:	09:08 AM
MET WITH:	ROSALIE SANDOVAL-ADMINISTRATOR		TIME COMPLETED:	12:30 PM

ALLEGATION(S):

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Resident sustained injury while in care.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Sanjay Vaid conducted a initial 10 day complaint visit to investigate the above allegation. Upon arrival LPA met Naylet Velasquez, Direct Staff/Designated Sub and 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#1-3 (S1-S3). LPA Vaid interviewed a total of five (5) residents, who shall be referred to as Resident #1- 5 (R1-R5). LPA interviewed Resident#1 (R1) via phone. LPA Vaid obtained staff and resident roster from Garfield Terrace and Garfield Villas.

The investigation reveals the following: Regarding the allegation: Resident sustained injury while in care. It is alleged that a resident had an unwitnessed fall in their room at the Garfield Terrace facility, when staff found them, they cleaned up the residents’ face and called the ambulance transport for the resident.
Continued on 9099C....

Unfounded

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: 03/11/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/11/2025

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-20250304112323

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: 03/11/2025

NARRATIVE

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Resident was transferred to Los Angeles Community Hospital. From there resident was sent to a skilled nursing facility for physical therapy and rehabilitation. Three (3) out of three (3) staff interviewed denied the allegations, the resident (R1) did not experience a fall at the Garfield Terrace facility. The resident (R1) does not reside at the Garfield Terrace facility. Resident roosters shows the resident (R1) not residing at Garfield Terrace. Four (4) out of four (4) residents interviewed could not corroborate the allegation. Five residents interviewed stated that R1 resides and lives not at the Garfield Terrace facility.

This agency has investigated the complaint alleging: Resident sustained injury while in care. We have found that the complaint was unfounded, meaning that the allegation was false, could not have happened and/or is without reasonable basis. We have therefore dismissed the complaint.

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

SUPERVISOR'S NAME: Fernando Fierros	TELEPHONE: (323) 981-3981
LICENSING EVALUATOR NAME: Sanjay Vaid	TELEPHONE: 916-215-7924
LICENSING EVALUATOR SIGNATURE:	DATE: 03/11/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/11/2025

LIC9099 (FAS) - (06/04)

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