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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198602243
Report Date: 10/28/2021
Date Signed: 10/28/2021 12:58:32 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
09/24/2020 and conducted by Evaluator David Sicairos
PUBLIC
COMPLAINT CONTROL NUMBER: 28-AS-20200924164736
FACILITY NAME:GARFIELD TERRACE LLCFACILITY NUMBER:
198602243
ADMINISTRATOR:SANDOVAL, ROSALIEFACILITY TYPE:
740
ADDRESS:1435 N GARFIELD AVETELEPHONE:
(626) 398-0527
CITY:PASADENASTATE: CAZIP CODE:
91104
CAPACITY:60CENSUS: 30DATE:
10/28/2021
UNANNOUNCEDTIME BEGAN:
11:45 AM
MET WITH:Rosalie Sandoval; AdministratorTIME COMPLETED:
01:13 PM
ALLEGATION(S):
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Staff fail to properly maintain resident's room.
Staff is not providing resident with proper sleeping arrangements.
Staff failed to ensure residents are properly fed while in care.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) David Sicairos conducted a subsequent complaint investigation regarding the allegations listed above. LPA met with Administrator Rosalie Sandoval and explained the reason for the visit.

The investigation consisted of the following: during the initial televisit conducted on 09/30/20, LPA conducted a virtual tour of Resident #1's room (R1). LPA attempted to conduct virtual tour of Resident #2's room (R2) however R2 refused to allow virtual tour of room. LPA also interviewed the Administrator, Staff #1 (S1), and R1 -R2. LPA obtained copies of staff and resident rosters. During today's visit, LPA toured the facility which included a random selection of resident rooms and interviewed Resident #3 (R3) - Resident #7 (R7) and Staff #1 (S1) - Staff #5 (S5).

The investigation revealed the following: in regards to the allegation "staff fail to properly maintain resident's room", it is alleged that R1's room is filthy and cluttered. During virtual tour conducted on 09/30/20, LPA observed R1's room was clean and free of clutter. During today's visit, LPA toured the facility and inspected a random selection of rooms and observed the rooms to be clean and free of clutter. (CONTINUED ON 9099C)
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Rebecca OrendainTELEPHONE: (323) 981-3961
LICENSING EVALUATOR NAME: David SicairosTELEPHONE: (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)
Page: 1 of 2
Control Number 28-AS-20200924164736
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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R1 no longer lives at the facility as of 01/04/21. 5 out of 5 residents interviewed today indicated that facility staff clean their rooms daily and change their linens weekly or as needed. 5 out of 5 staff members interviewed indicated that housekeeping staff clean daily however some residents are cleaner than others but staff try to keep facility clean and free of clutter as much as possible. Therefore there was insufficient evidence to corroborate with allegation.

In regards to the allegation "staff is not providing resident with proper sleeping arrangements", it is alleged that R2 has been using her room as a storage unit and as a result has been sleeping on a chair in the tv room. Interview conducted with R2 revealed that she sometimes chooses to sleep in the tv room because she feels that she can get "more air" while sleeping outside of her room. R2 indicated that she has proper sleeping arrangements in her room. 5 out of 5 residents interviewed today indicated that facility provides proper sleeping arrangements for them. 4 out of 5 staff members interviewed indicated that they would to prompt and encourage R2 to sleep in her room, however R2 sometimes refused. Facility staff indicated that R2 was a hoarder who refused assistance from staff and did not want staff to clean her room. Administrator bought R2 a new bed and storage containers for her belongings however R2 refused the items. R2 no longer lives at the facility since 01/26/21. LPA toured a random selection of resident rooms and observed proper sleeping arrangements in all of the rooms. Therefore there was insufficient evidence to corroborate with this allegation.

In regards to the allegation "staff failed to ensure residents are properly fed while in care" it is alleged that S1 is refusing to feed residents breakfast and instead sits down and plays on her phone in the office. Interview conducted with S1 denied this allegation. 5 out of 5 residents interviewed today indicated that facility provides 3 meals and 2 snacks daily. Residents also indicated that staff will assist them with eating if they request help from staff. 5 out of 5 staff members interviewed indicated that they assist residents with feeding and do not ignore residents who need assistance. Staff members interviewed also indicated that personal phone use is prohibited while on the clock unless its for an emergency. 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 OrendainTELEPHONE: (323) 981-3961
LICENSING EVALUATOR NAME: David SicairosTELEPHONE: (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)
Page: 2 of 2