198602243-10-28-2021-28-AS-FFIS-C8U2CK-20211116161649

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198602243
Report Date: 10/28/2021
Date Signed: 10/28/2021 12:20:52 PM

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
10/25/2021 and conducted by Evaluator David Sicairos

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20211025091525

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: 30	DATE:	10/28/2021
		UNANNOUNCED	TIME BEGAN:	09:30 AM
MET WITH:	Rosalie Sandoval; Administrator		TIME COMPLETED:	11:45 AM

ALLEGATION(S):

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Staff handled resident in a rough manner.
Staffing is not sufficient to meet residents needs.
Staff are not regularly checking on residents.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) David Sicairos conducted an initial complaint investigation regarding the allegations listed above. LPA met with Administrator Rosalie Sandoval and explained the reason for the visit.

The investigation revealed the following: during today's visit, LPA toured the facility which included the common areas and interviewed Resident #1 (R1) - Resident #5 (R5) and Staff #1(S1) - Staff #5 (S5). LPA also obtained copies of Staff & Resident Rosters and Special Incident Reports involving R1.

The investigation consisted of the following: in regards to the allegation "staff handled resident in a rough manner", it is alleged that S1 has tripped R1 and has also interacted with R1 in a rough manner such as engaging in arm wrestling. Interviews conducted with S1 and R1 both denied this allegation. The other 4 out 4 residents interviewed indicated they have never been handled in a rough manner by staff. The other 4 out 4 staff members interviewed indicated that they have never handled any residents in a rough manner. Therefore there was insufficient evidence to corroborate with this allegation.

(CONTINUED ON 9099C)

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Rebecca Orendain	TELEPHONE: (323) 981-3961
LICENSING EVALUATOR NAME: David Sicairos	TELEPHONE: (323) 981-3961
LICENSING EVALUATOR SIGNATURE:	DATE: 10/28/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/28/2021

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-20211025091525

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: 10/28/2021

NARRATIVE

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In regards to the allegation "staffing is not sufficient to meet residents needs", it is alleged that there is only one staff member present at the facility at 7am when the graveyard shift staff leave. There is no medication aide staff present. Interview with Administrator revealed that there are currently 21 staff members employed at the facility for a total of 30 residents. 5 out 5 staff members interviewed indicated that there are usually 3 staff members present at the facility at 7am including a medication aide staff. 5 out 5 residents interviewed indicated that there are at least 3 staff members present at the facility at 7am. Therefore there was insufficient evidence to corroborate with this allegation.

In regards to the allegation "staff are not regularly checking on residents", it is alleged that S1 does not do room checks as required. S1 allegedly completes the room check sheet, but does not do the room checks. 5 out of 5 staff members interviewed denied this allegation. Staff members interviewed indicated that room checks are conducted at least every 2 hours. 5 out of 5 residents interviewed indicated that room checks are conducted every 2 hours. LPA obtained copies of room check sheets completed from the last 2 weeks. Room check sheets show residents are checked on every 2 hours. Therefore there was insufficient evidence to corroborate with this allegation.

Based on statements and interviews conducted with staff, residents, review of resident files and facility file records, there was not enough supportive evidence to concur with the reported allegations. 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 allegations are UNSUBSTANTIATED.

Exit interview held, and a copy of this report was provided.

SUPERVISOR'S NAME: Rebecca Orendain	TELEPHONE: (323) 981-3961
LICENSING EVALUATOR NAME: David Sicairos	TELEPHONE: (323) 981-3961
LICENSING EVALUATOR SIGNATURE:	DATE: 10/28/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/28/2021

LIC9099 (FAS) - (06/04)

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