198602244-1-19-2023-28-AS-RORN-CNM2FR-20230131162158

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198602244
Report Date: 11/28/2022
Date Signed: 01/19/2023 09:40:34 AM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
GREATER LA AC/SC, 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
11/14/2022 and conducted by Evaluator Bennette Pena

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20221114133813

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:	11/28/2022
		UNANNOUNCED	TIME BEGAN:	02:30 PM
MET WITH:	Facility Supervisor, Jay Viado		TIME COMPLETED:	04:15 PM

ALLEGATION(S):

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Staff speak inappropriately to clients in care.
More than two clients sleep in one bedroom.
Facility does not have telephone service on the premises.
Clients are not provided proper food service.
Clients in care are not provided with supplies necessary for personal care and maintenance of personal hygiene.

INVESTIGATION FINDINGS:

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**********This is the second (2nd) amended version of the original report created on 11/28/2022. This report is being amended to remove confidential information. No other changes have been made and investigation findings remain the same. **********

Licensing Program Analyst (LPA) Bennette Pena made an unannounced visit to the facility and was greeted by Jerrilene Lagasca, Activity Director (Staff #7/S7). LPA was screened for covid upon entry and conducted a risk assessment. LPA spoke with S1 on the phone to discuss the purpose of today's visit and explained that LPA will deliver findings. S3 arrived at 3:30pm and confirmed the number of covid positive cases at the facility. S3 confirmed that there are currently four (4) clients who are covid positive and in isolation.

The purpose of this visit is to conduct a subsequent visit and deliver the findings pertaining to the above-mentioned allegations. An initial 10-Day visit was conducted on 11/21/2022 by LPA Bennette Pena. During the last visit, LPA Pena obtained copies of the following: staff/resident roster, in-service training (personal rights), House rules, Service report from electrician regarding phone service (dated 11/17/2022), personal hygiene supplies log, copy of the monthly menu, interviewed Staff #1-Staff #6 (S1-S6), Resident #1-Resident #10 (R1-R10). LPA Pena also conducted a tour of the facility which included the office, front entrance, common areas, hallways, dining area and kitchen area.
******REPORT CONTINUED ON LIC 9099-C******

Unsubstantiated

Estimated Days of Completion:

NAME OF LICENSING PROGRAM MANAGER: David Sicairos
NAME OF LICENSING PROGRAM ANALYST: Bennette Pena
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 11/28/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/28/2022

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 4

Control Number 28-AS-20221114133813

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
GREATER LA AC/SC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754

FACILITY NAME: PASADENA ADULT LIVING CENTER	FACILITY NUMBER: 198602244
	VISIT DATE: 11/28/2022

NARRATIVE

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Regarding Allegation #1: Staff speak inappropriately to clients in care. Interviews with S1-S6 revealed that they have not heard, seen or witnessed any staff speak inappropriately to clients. All of them stated that they have not heard anyone complaint about being spoken to inappropriately by staff. S1-S6 denied the allegation and stated that the clients are accorded dignity in their relationships with staff and other clients who live there. Staff interviewed indicated that they have not spoken to any clients inappropriately and they speak to the clients with respect. Staff interviewed indicated that they know how to manage clients behaviors and staff understand that they have to be patient with them. Nine (9) out of ten (1) clients interviewed stated that they have not heard, seen or witnessed any staff speak inappropriately to them or other clients who live there. LPAs' observation during the visit showed that staff speak to the clients appropriately and there is no evidence that corroborates the allegation.

Based on the observation and interviews conducted, 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 of Staff speak inappropriately to clients in care is found to be UNSUBSTANTIATED.

Regarding Allegation #2: More than two clients sleep in one bedroom. Investigation revealed that S1-S6 stated that there are only two (2) clients allowed to sleep in one bedroom (shared bedroom). Outside visitors are not allowed in the clients bedroom, they stay outside in the patio. Staff interviewed denied the allegation and indicated that even if both clients are girlfriend/boyfriend the facility does not allow the clients to sleep in the same room. Staff allows them to hang out in each other's room as long as their room mate is okay with it or allows it. If it doesn't interfere with the privacy of the room mate, staff normally allows them to hang out in the room but not sleep together. Interviews with nine (9) out of 10 clients stated that they have not seen more than two (2) people sleep in one bedroom.

Based on statements and interviews conducted with clients and staff, there was not enough supportive evidence to corroborate the allegation.

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.

*******REPORT CONTINUED ON LIC 9099-C******

NAME OF LICENSING PROGRAM MANAGER: David Sicairos
NAME OF LICENSING PROGRAM ANALYST: Bennette Pena
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 11/28/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/28/2022

LIC9099 (FAS) - (06/04)

Page: 2 of 4

Control Number 28-AS-20221114133813

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
GREATER LA AC/SC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754

FACILITY NAME: PASADENA ADULT LIVING CENTER	FACILITY NUMBER: 198602244
	VISIT DATE: 11/28/2022

NARRATIVE

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Regarding Allegation #3: Facility does not have telephone service on the premises. The investigation revealed that the facility provided telephone service to clients. Staff interviewed denied the allegation, staff indicated that a facility phone was broken not too long ago. An electrician and telephone service provider came by to fix it, however there are other telephones that are available for clients' use. S2-S6 stated that telephone service is provided by the facility to clients all the time. Currently, there are two (2) telephones provided for clients use, one (1) is a pay phone and the other one (1) is in the office, both are working. Normally there are three (3) phones provided. S1-S3 stated that the third phone was broken a week ago because one of the clients got mad and ripped the cable/broke the phone. S1 -S3 stated that they extended the phone cable wire so that the clients can use the phone outside the office. And if they need privacy, they can go inside the office. Nine (9) out of ten (10) clients interviewed stated that they have access to telephone anytime they need it. Some of them have cell phones and do not need to use the facility's public phone, some do not have anyone to call. All of them stated that they are aware of the pay phone, and they use it for 800 calls or emergency calls like 911.

Based on statements and interviews conducted with clients and staff as well as LPAs documents reviewed (service report on 11/17/2022), there was not enough supportive evidence to corroborate the allegation.

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.

***REPORT CONTINUED ON LIC9099-C***

NAME OF LICENSING PROGRAM MANAGER: David Sicairos
NAME OF LICENSING PROGRAM ANALYST: Bennette Pena
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 11/28/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/28/2022

LIC9099 (FAS) - (06/04)

Page: 3 of 4

Control Number 28-AS-20221114133813

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
GREATER LA AC/SC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754

FACILITY NAME: PASADENA ADULT LIVING CENTER	FACILITY NUMBER: 198602244
	VISIT DATE: 11/28/2022

NARRATIVE

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Regarding Allegation #4: Clients are not provided proper food service. It was alleged that for breakfast, clients only receive pancakes, small portion of fruit, and coffee and clients are always missing bacon, sausage, hash browns, and oatmeal. And that clients are also served sandwiches and soup for several days in a row and there is no variety of foods served to them. Investigation revealed the following: Nine (9) out of ten (10) clients denied the allegation and they all indicated that they like the food in the facility and have no complaints. All of them stated that the quality of food is good, and they can even get 2nd serving if they ask. They also stated that if they do not like the menu offered for the day, they can request to get a sandwich instead, but they need to request it ahead of time so it can be prepared for them. S6 stated that the facility provides three (3) full meals a day, in addition to three (3) snacks a day. S6 stated that a dietician comes every month and speak with clients and then they start planning the menu for the month. S1-S6 stated that they have not heard anyone complained about the food or the serving. LPA observed that the facility offers a variety and balanced meal based on their daily/weekly menus.

Based on statements and interviews conducted with clients and staff as well as LPAs documents reviewed, there was not enough supportive evidence to corroborate the allegation.

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.

Regarding Allegation #5: Clients in care are not provided with supplies necessary for personal care and maintenance of personal hygiene. It was alleged that for the past two months, staff have not provided clients with conditioner, lotion, and feminine products. Based on interviews with S1-S6, all of them stated that the facility provides personal hygiene supplies to clients. Staff interviewed indicated that hygiene supplies are available to clients at all times, clients just need to come to the office and ask. Staff interviewed indicated they have personally provided clients with hygiene supplies and have never refused to provide clients with supplies. Staff interviewed indicated that monthly orders are placed for supplies through their HR Dept. Interviews with nine (9) out of ten (10) clients revealed that they have no complaints and get enough supplies if they need it. Some of them buy their own shampoo and conditioner and do not get their supplies from the office. All of them are aware that the office provides the supplies, and they just go to the office and ask for it. They all stated that they get enough supplies. LPA observed that the facility has enough personal hygiene supplies for the clients.

Based on statements and interviews conducted with clients and staff as well as LPAs' observations, there was not enough supportive evidence to corroborate the allegation.

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.

Exit interview, a copy of this report and Appeals Rights were provided to the Facility Administrator, Ruby Garcia.

NAME OF LICENSING PROGRAM MANAGER: David Sicairos
NAME OF LICENSING PROGRAM ANALYST: Bennette Pena
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 11/28/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/28/2022

LIC9099 (FAS) - (06/04)

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