198602244-4-20-2022-28-AS-FFIS-CQUT35-20230413142142

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198602244
Report Date: 04/20/2022
Date Signed: 04/20/2022 04:54:15 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
02/06/2020 and conducted by Evaluator Gail Johnson

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20200206154936

FACILITY NAME:	PASADENA ADULT LIVING CENTER		FACILITY NUMBER:	198602244
ADMINISTRATOR:	GARCIA, RUBY		FACILITY TYPE:	735
ADDRESS:	1415 N GARFIELD AVE		TELEPHONE:	(626) 398-9647
CITY:	PASADENA	STATE: CA	ZIP CODE:	91104
CAPACITY:	136	CENSUS: 99	DATE:	04/20/2022
		UNANNOUNCED	TIME BEGAN:	02:02 PM
MET WITH:	Ruby Garcia		TIME COMPLETED:	05:00 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Staff does not provide resident adequate care and supervision.

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
11
12
13

On 04/20/2022 around 2:00 pm, Licensing Program Analyst (LPA) Gail Johnson and Licensing Program Manager (LPM) Ulysses Coronel arrived at Pasadena Adult Living Center and conducted an unannounced complaint investigation. LPA and LPM met with Administrator Ruby Garcia and the purpose of the visit was explained.
The investigation consisted of the following: On 02/13/2020 LPA Bonnie Tao interviewed three (3) staff and six (6) out of 120 clients. LPA Tao obtained a copy of staff records, client records and toured facility. On 04/20/2022, LPA Johnson and LPM Coronel interviewed Administrator Garcia, reviewed facility and client C1’s records.
The investigation revealed the following: Regarding the allegation “Staff does not provide resident adequate care and supervision” it is alleged that the facility is not preventing C1 from AWOLs (Absent Without Leave). On 02/13/2020, four (4) out of six (6) clients interviewed did not agree with the allegation, client C3 stated “It’s alright, it’s better than some other board and care”.

Unsubstantiated

Estimated Days of Completion:

NAME OF LICENSING PROGRAM MANAGER: Eva M Alvarez
NAME OF LICENSING PROGRAM ANALYST: Gail Johnson
LICENSING PROGRAM ANALYST 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)

Page: 1 of 2

Control Number 28-AS-20200206154936

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: PASADENA ADULT LIVING CENTER	FACILITY NUMBER: 198602244
	VISIT DATE: 04/20/2022

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

One (1) out of six (6) clients interviewed agreed with the allegation, client C8 stated “Not happy with the facility and management, but it is better than living on the street. One (1) out of six (6) clients C9 declined to be interviewed. Three (3) out of three (3) staff interviewed denied the allegation. On 4/20/2022 record reviews indicate that, the facility’s in-house psychiatrist was in contact with C1 from 12/03/2014 to 02/26/2020 and needs and services plan were conducted on an annual basis. The most recent needs and services plan was conducted on 05/02/2019. On 04/20/2022, Administrator Garcia stated “We are not a locked facility, clients have the right to come and go as they please. During admission we advise the clients to use the sign-out sheet, we ask them to let us know when they plan to come back and where they are going. We explain to them, that if they are AWOL within 24 hours a missing person police report will be made. We don’t want to kick clients out in the streets. C1 went AWOL on 06/01/2020 and did never returned". Regarding the allegation “Staff does not provide resident adequate care and supervision”.

Although the allegation 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.

An exit interview was conducted.

A copy of this report was provided to Administrator Ruby Garcia.

NAME OF LICENSING PROGRAM MANAGER: Eva M Alvarez
NAME OF LICENSING PROGRAM ANALYST: Gail Johnson
LICENSING PROGRAM ANALYST 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)

Page: 2 of 2