198602243-6-16-2023-28-AS-TVAO-CT9P4H-20230629105909

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198602243
Report Date: 06/16/2023
Date Signed: 06/16/2023 08:23:00 PM

Substantiated

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
06/13/2023 and conducted by Evaluator Kimberly Ramirez

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20230613170845

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: 27	DATE:	06/16/2023
		UNANNOUNCED	TIME BEGAN:	10:21 AM
MET WITH:	Rosalie Sandoval		TIME COMPLETED:	05:00 PM

ALLEGATION(S):

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Facility is not providing a safe environment for residents in care.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Kimberly Ramirez conducted an unannounced initial complaint investigation visit regarding the above allegations. LPA Ramirez was met by Administrator Rosalie and explained the purpose of the visit.

The investigation consisted of the following: LPA Ramirez requested and obtained copies of staff roster and resident roster. LPA Ramirez conducted interviews with administrator (S1), licensee (S2) over the phone, staff #3 (S3), #4 (S4) and residents #1 (R1), #2 (R2), #3 (R3). LPA Ramirez contacted ERC Case Manager and left a message requesting a call back. LPA Ramirez requested and obtained a copy of the following documents: face sheet for R1 and R2, physician report for R1 and R2, identification and emergency sheet for R1 and R2, and unusual incident/injury report for R1.

SEE 9099-C for continuation...

Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Tony Vasallo	TELEPHONE: (323) 981-3977
LICENSING EVALUATOR NAME: Kimberly Ramirez	TELEPHONE: (323) 981-3970
LICENSING EVALUATOR SIGNATURE:	DATE: 06/16/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/16/2023

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-20230613170845

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: 06/16/2023

NARRATIVE

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The investigation revealed the following: Allegation- Facility is not providing a safe environment for residents in care. It is alleged facility staff are not providing a safe environment for residents in care by continually allowing residents to slam doors, be verbally and physically abusive towards other residents. Records review revealed R1 moved in this facility on 10/30/2018 and was accepted into the facility with a known history of substance abuse. Unusual Incident/Injury Reports (LIC 624) dated 03/07/22, 04/05/22, 07/21/22, 10/23/22, 11/29/22, 05/02/23, 06/01/23 and 06/11/23 revealed R1 has a history being intoxicated at the facility and refusing to seek medical attention. LIC 624 dated 03/07/22, revealed administrator Sandoval reported R1 needs Drug and Alcohol Treatment or Behavioral Therapy after R1 had a fall, R1 attempted to hit a staff member that was trying to render aid and that R1’s substance abuse problem has gotten worse. LIC 624 dated 11/29/22, revealed administrator Sandoval reported R1 had a fall and appeared to be intoxicated. Facility staff called 911 and when EMS arrived, R1 was combative, and police were called to assist. R1 refused medical treatment and it was reported that R1’s case manager and staff removed several empty bottles of Vodka from R1. On 12/7/22, the facility served R1 with a 30-Day Notice to Terminate Tenancy based on R1’s behavior of jeopardizing his and others health and safety. Per the eviction notice, the facility stated “Facility can no longer assist R1 with care that is needed as R1 refuses and becomes combative with staff, paramedics, firemen etc. R1 has a tendency to become violent when consuming alcohol. Four (4) out of the four staff interviewed confirmed that R1 has a history of becoming combative with staff and residents while intoxicated at the facility. Staff #3 stated “We get in between R1 and other residents when they verbally argue.” LIC 624 dated 05/02/23, revealed R1 was verbally arguing with another resident and was observed to be intoxicated. Staff observed R1 stagger down the south-side of hallway and laid in the floor. R1 refused medical treatment. Administrator Sandoval reported that other residents complained of “R1’s yelling at night and keeping them up depriving them of their sleep.” LIC 624 dated 06/01/23, revealed R1 was discovered laying on the ground by staff and was intoxicated. Staff was not sure if R1 fell or laid down, according to LIC 624. Staff attempted to assist R1 but, R1 began swinging his arms and cursing at staff. R1 refused medical assistance. LIC 624 dated 6/11/23, revealed R1 and R2 got into a verbal argument which led to R1 grabbing R2 by the shirt. R2 then hit R1 in the face and R1 in turn hit R2 back in the face. Staff intervened by placing themselves in between residents. Police were called but no arrests or report was taken. Neither R1 or R2 sustained any injuries. Two (2) out of the three residents interviewed confirmed to have seen and heard R1 be verbally abusive towards staff and residents.

SEE 9099-C for continuation...

SUPERVISOR'S NAME: Tony Vasallo	TELEPHONE: (323) 981-3977
LICENSING EVALUATOR NAME: Kimberly Ramirez	TELEPHONE: (323) 981-3970
LICENSING EVALUATOR SIGNATURE:	DATE: 06/16/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/16/2023

LIC9099 (FAS) - (06/04)

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Control Number 28-AS-20230613170845

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: 06/16/2023

NARRATIVE

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Per facility house rules, A resident, or as indicated, may not do any of the following which constitutes a violation of the facility’s house rules. Any violation of the rules set below may be grounds for eviction:

1. Verbal or physical abuse directed towards other residents or staff.

2. Harming or threatening to harm oneself or others.

3. Health conditions that require staffing levels not available in the facility.

4. Having alcohol or other intoxicating substances without the express permission of the physician and licensee.

LPA could not locate any new care plan or any other pertinent documentation that suggest the facility attempted to seek new housing based on R1 needs and services after R1’s 30-day eviction notice and after the facility acknowledged in the eviction notice that the facility could no longer assist R1 with care R1s care and needs.

Based on interviews conducted and records review, the preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED.

California Code of Regulations, Tittle 22, Division 6 and Chapter 8 are being cited. Exit interview conducted with administrator Rosalie Sandoval and a copy of this report, LIC 9099-C, LIC 9099-D and appeals rights were provided via email due to printer problems.

SUPERVISOR'S NAME: Tony Vasallo	TELEPHONE: (323) 981-3977
LICENSING EVALUATOR NAME: Kimberly Ramirez	TELEPHONE: (323) 981-3970
LICENSING EVALUATOR SIGNATURE:	DATE: 06/16/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/16/2023

LIC9099 (FAS) - (06/04)

Page: 3 of 4

Control Number 28-AS-20230613170845

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
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 06/16/2023

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Request Denied Type A 06/19/2023 Section Cited CCR 87468.1	1 2 3 4 5 6 7	87468.1 Personal Rights of Residents in All Facilities (a) Residents in all residential care facilities for the elderly shall have all of the following personal rights: (2) To be accorded safe, healthful and comfortable accommodations, furnishings and equipment.	1 2 3 4 5 6 7	Provide LPA with documented needs and services plan to assist R1 with treatment based on care needs and provide adequate supervision,
	8 9 10 11 12 13 14	Based on records review and interviews, the Licensee failed to provide a safe environment for residents in care by not ensuring R1 received proper care to address substance abuse problem and continued to house R1 after the facility acknowledged they could no longer assist R1 with care that is needed.	8 9 10 11 12 13 14
	1 2 3 4 5 6 7		1 2 3 4 5 6 7
	1 2 3 4 5 6 7		1 2 3 4 5 6 7

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

SUPERVISOR'S NAME: Tony Vasallo	TELEPHONE: (323) 981-3977
LICENSING EVALUATOR NAME: Kimberly Ramirez	TELEPHONE: (323) 981-3970
LICENSING EVALUATOR SIGNATURE:	DATE: 06/16/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/16/2023

LIC9099 (FAS) - (06/04)

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