198602244-7-11-2023-28-AS-RORN-CWHULW-20231011154126

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198602244
Report Date: 07/11/2023
Date Signed: 07/11/2023 01:18:01 PM

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
07/06/2023 and conducted by Evaluator Christine Wong

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20230706125337

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: 93	DATE:	07/11/2023
		UNANNOUNCED	TIME BEGAN:	09:15 AM
MET WITH:	Ruby Garcia		TIME COMPLETED:	01:40 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Facility staff did not provide adequate supervision to residents resulting in a resident sexually harassing another resident in care.
Facility staff did not allow resident to file a complaint.

INVESTIGATION FINDINGS:

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

Licensing Program Analyst (LPA) Christine Wong conducted the “Initial 10-Day” visit to ascertain information pertaining to the above-mentioned allegation(s) and to establish the validity of the complaint. LPA met with Medication Supervisor Clarissa Basto who allowed entry into the facility and was later met by Administrator Ruby Garcia who assisted with the visit.

The investigation consisted of the following: On today's date, LPA Wong interviewed the administrator, six (6) staff (S1-S6) and ten (10) clients and obtained copy of staff and client rosters and C1's documents ID and Emergency Infomration, Physician Report, doctor notes, Needs and Service Plan, Incident Reports and some notes from C1 to the facility.

(See LIC 9099C for continuation)

Unsubstantiated

Estimated Days of Completion:

NAME OF LICENSING PROGRAM MANAGER: David Sicairos
NAME OF LICENSING PROGRAM ANALYST: Christine Wong
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 07/11/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/11/2023

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-20230706125337

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: 07/11/2023

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

The investigation revealed of the following: Allegation#1 "Facility staff did not provide adequate supervision to residents resulting in a resident sexually harassing another resident in care." LPA interviewed ten clients and seven out of ten clients denied the allegation and reported they had never seen or witnessed or got any sexually harassment from other clients. Staff always addressed the issues immediately if something happened in the facility. LPA interviewed staff and administrator and all denied the allegation. All the clients are very respectful in the facility. They never witnessed any clients sexually harassed any clients in the facility. Administrator reported if there's anything happened, they would call the police and report and address it immediately. Administrator stated sometimes clients may not put on a shirt or their pants were too loose, the staff always reminded clients to put the shirt back on or provided them with a belt or a smaller sized pants.

Allegation#2 "Facility staff did not allow resident to file a complaint." LPA interviewed ten clients and nine out of ten clients denied the allegation. Some of the clients reported they had never filed a complaint, so they did not know. Some clients reported staff never did it to them and they have their right to file the complaint. LPA interviewed staff and reported they would never do it to clients. It is client's right and they have no control of it. They cannot stop client doing it. Administrator also denied taking phone away from client while client filed the complaint.

Based on the observation, interviews conducted with staff and clients and documents reviewed, 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 and appeal right were issued.

NAME OF LICENSING PROGRAM MANAGER: David Sicairos
NAME OF LICENSING PROGRAM ANALYST: Christine Wong
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 07/11/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/11/2023

LIC9099 (FAS) - (06/04)

Page: 2 of 2