198602243-4-20-2022-28-AS-MVAO-CE4SEQ-20220504134907

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198602243
Report Date: 04/20/2022
Date Signed: 04/20/2022 12:26:54 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office,
, CA

This is an official report of an unannounced visit/investigation of a complaint received in our office on
04/14/2020 and conducted by Evaluator Gail Johnson

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20200414084328

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:	04/20/2022
		UNANNOUNCED	TIME BEGAN:	09:45 AM
MET WITH:	Elizabeth Saavedra		TIME COMPLETED:	12:45 PM

ALLEGATION(S):

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Unlawful eviction.

INVESTIGATION FINDINGS:

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On 04/20/2022 around 9:50 am, Licensing Program Analyst (LPA) Gail Johnson and Licensing Program Manager (LPM) Ulysses Coronel arrived at Garfield Terrace LLC and conducted an unannounced complaint visit. LPA and LPM met with designated staff Medication aide Elizabeth Saavedra and the purpose of the visit was explained.

The investigation consisted of the following: On 04/21/2020 LPA Elizabeth Irra interviewed the facility administrator and requested resident and staff records. On 04/19/2022 LPA Johnson reviewed resident and staff records. On 04/20/22 LPA Johnson and LPM Coronel interviewed Administrator Rosalie Sandoval, Medication Aide Naylet Velazquez & Medication Aide Elizabeth Saavedra and reviewed R1’s and the facility's records.

Report continued on LIC-9099C

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Eva M Alvarez	TELEPHONE: (323) 629-7047
LICENSING EVALUATOR NAME: Gail Johnson	TELEPHONE: (626) 228-4917
LICENSING EVALUATOR SIGNATURE:	DATE: 04/20/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/20/2022

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-20200414084328

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office,
, CA

FACILITY NAME: GARFIELD TERRACE LLC	FACILITY NUMBER: 198602243
	VISIT DATE: 04/20/2022

NARRATIVE

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The investigation revealed the following: Regarding the allegation “Unlawful eviction”, it is alleged that the facility refused to accept the resident R1 back from the hospital. On 4/20/2022 record reviews indicate that; on 04/08/2020 the facility told the hospital that a bed was available for R1 after being told that R1 was ready for discharge, and that at 1:03pm that same day R1’s placement agency called the hospital and said that the facility would not be taking R1 back due to R1’s recent behaviors and due to the facility not having enough staff to care for R1’s needs. On 04/20/2022 the administrator Sandoval stated, “I did not say she could not come back to the facility.” Medication Aide Naylet Velazquez denied the allegation and stated “No we would not make that decision, it would be made by the hospital psychiatrist depending on their assessment if the resident is to come back.” Regarding the allegation “Unlawful eviction”: Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is Unsubstantiated.

No deficiencies were cited during today's visit.

An exit interview was conducted.

A copy of this report was provided to Medication Aide Naylet Velazquez.

SUPERVISOR'S NAME: Eva M Alvarez	TELEPHONE: (323) 629-7047
LICENSING EVALUATOR NAME: Gail Johnson	TELEPHONE: (626) 228-4917
LICENSING EVALUATOR SIGNATURE:	DATE: 04/20/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/20/2022

LIC9099 (FAS) - (06/04)

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