198602244-6-9-2022-28-AS-SCOL-CFSU59-20220627151620

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198602244
Report Date: 06/09/2022
Date Signed: 06/09/2022 04:50:07 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, 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
06/03/2022 and conducted by Evaluator Noemi Galarza

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20220603151552

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: 97	DATE:	06/09/2022
		UNANNOUNCED	TIME BEGAN:	10:13 AM
MET WITH:	Ruby Garcia, Administrator		TIME COMPLETED:	04:55 PM

ALLEGATION(S):

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Staff did not prevent resident from engaging in inappropriate behaviors.
Staff made inappropriate comment towards resident.

INVESTIGATION FINDINGS:

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Licensing Program Analysta (LPAa) Galarza and Ya Ting Yang conducted an unannounced visit regarding the above allegations and delivered findings. The purpose of the visit was explained to Administrator Ruby Garcia

The investigation consisted of: A physical plant tour of the interior and exterior was conducted. Staff (S1- S4) and clients (C1-C12) were interviewed. Client (C13) was not present at the facility. Video surveillance was reviewed pertaining to allegations substantiated in the other report. The following documents were obtained pertaining to client (C1 & C2): Face Sheet, Physician Report, Appraisal Needs and Services Plan, incident report (5/31/22), Preplacement Appraisal Information, LIC 500 Personnel Report, resident roster, and C1's notes to Administrator.

See LIC 9099C for report continuation.

Unsubstantiated

Estimated Days of Completion:

NAME OF LICENSING PROGRAM MANAGER: Lisa Hicks
NAME OF LICENSING PROGRAM ANALYST: Noemi Galarza
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 06/09/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/09/2022

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-20220603151552

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: PASADENA ADULT LIVING CENTER	FACILITY NUMBER: 198602244
	VISIT DATE: 06/09/2022

NARRATIVE

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Allegation: "Staff did not prevent resident from engaging in inappropriate behaviors." It is alleged that client (C4) and C13 walk around the facility with their pants low/sagging, which makes some residents feel uncomfortable and/or harassed. Per interviews conducted, staff have been informed of these behaviors, but staff have not addressed clients in question regarding inappropriate dressing. One client reported that C13 purposely walks around with the pants zipper down, and with it's private anatomical part exposed. This alleged incident occurred during the nighttime/evening hours. It is alleged that C4's pants are very low, and makes C1 feel sexually harassed. Client (C4) denied intentional behavior towards C1, and stated it wears it's pant low because of style and most recently it's belt has not fit properly. Client (C13) was not at the facility at the time of the visit, and was not interviewed. All staff stated they have not seen C4 or C13 expose themselves to anyone, nor do they wear their pants offensively low. Eight (8) of of 12 clients denied this allegation. During today's interview, LPAs observed C4 was wearing it's short slightly low, partially showing it's underwear, but not exposing any skin.

Allegation: "Staff made inappropriate comment towards resident." It is alleged that staff (S1)/Administrator told client (C1) to keep it's mouth shut. According to client (C1) Administrator told C1 to leave C2 alone, instead of addressing that C2 punched C1 in the face. Administrator stated that C1 does not respond well to disciplinary direction, and all staff try to accommodate the client with it's needs. Ten (10) out of 12 clients denied this allegation. The majority of clients interviewed stated Administrator is professional and does not make inappropriate comments to them. All staff interviewed denied this allegation. There is insufficient supportive evidence to prove this allegation.

Although the allegation(s) may have happened or are valid, there are not a preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegation(s) are UNSUBSTANTIATED.

An exit interview was conducted with Administrator Ruby Garcia. A copy of the report was issued.

NAME OF LICENSING PROGRAM MANAGER: Lisa Hicks
NAME OF LICENSING PROGRAM ANALYST: Noemi Galarza
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 06/09/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/09/2022

LIC9099 (FAS) - (06/04)

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