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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198602244
Report Date: 12/19/2023
Date Signed: 12/19/2023 01:25:58 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
12/11/2023 and conducted by Evaluator Jose Villalobos
PUBLIC
COMPLAINT CONTROL NUMBER: 28-AS-20231211102703
FACILITY NAME:PASADENA ADULT LIVING CENTERFACILITY NUMBER:
198602244
ADMINISTRATOR:GARCIA, RUBYFACILITY TYPE:
735
ADDRESS:1415 N GARFIELD AVETELEPHONE:
(626) 398-9647
CITY:PASADENASTATE: CAZIP CODE:
91104
CAPACITY:136CENSUS: 86DATE:
12/19/2023
UNANNOUNCEDTIME BEGAN:
09:15 AM
MET WITH:Administrator Ruby Garcia TIME COMPLETED:
01:30 PM
ALLEGATION(S):
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Staff are financially abusing client in care
Client is being sexually harassed in facility
Staff not affording dignity towards resident
Staff refusing to repair physical plant
Staff is threatening to evict client, due to complaints.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Jose Villalobos conducted an unannounced complaint investigation visit for the allegation(s) above. LPA met with Administrator Ruby Garcia and the purpose of the visit was discussed.

On todays visit LPA conducted the following: LPA interviewed Staff #1-#6 (S1-S6) and clients #1-#7 (C1-C7). LPA collected a copy of the staff and client roster. LPA reviewed C1's file and collected copies of C1's ID and Emergency Information, Physicians Report, Needs and Services Plan, Preplacement appraisal, Physician progress notes, Admissions agreement and an incident report dated 5/23/23. The investigation revealed the following:

In regards to the allegation "Staff are financially abusing client in care" it was alleged that the facility refused to provide C1 with 1 million dollars owed to C1. (6) of (6) Staff interviewed denied the allegation. (6) of (7) Clients interviewed could not corroborate the allegation...

Continued on LIC 9099-C
Unsubstantiated
Estimated Days of Completion:
NAME OF LICENSING PROGRAM MANAGER: Fernando Fierros
NAME OF LICENSING PROGRAM ANALYST: Jose Villalobos
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 12/19/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/19/2023
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 3
Control Number 28-AS-20231211102703
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: 12/19/2023
NARRATIVE
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C1 was unable to state why the facility owed C1 a million dollars. Interviews show that the facility does not even handle funds for C1 as C1 has their responsible party handle their financial affairs. LPA did not observe any documentation to show that C1 was owed a million dollars from the facility. Based on interviews, observations and file review conducted, 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.

In regards to the allegation "Client is being sexually harassed in facility" it was alleged that other clients of the facility are sexually harassing C1 and the staff do not intervene. (6) of (6) Staff interviewed denied the allegation. (6) of (7) Clients interviewed could not corroborate the allegation. Interviews show that C1 will state other clients are sexually harassing C1 when C1 observes clients with saggy pants. Interviews with staff state C1 has a history of accusing black male clients of sexual harassment that turn out to not be true. Clients interviewed denied observing or hearing of C1 being sexually harassed. File review shows incident report on 5/23/23 of C1 reporting to staff that they were sexually harassed because C2 walked around with their pants sagging. Report shows S1 addressed the situation with clients in care. C1 was unable to provide LPA with examples of being sexually harassed in the facility. Based on interviews, observations and file review conducted, 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.

In regards to the allegation "Staff not affording dignity towards resident" it was alleged that staff spread rumors of C1 being a whore. (6) of (6) Staff denied the allegation. (6) of (7) Clients interviewed could not corroborate the allegation. Staff interviewed denied that anyone would spread rumors about C1. Interviews state that C1 claiming people spread rumors about C1 is part of their behavior and condition. LPA reviewed C1's file and observed documentation that C1 has a history of claiming staff spread rumors about C1. LPA was not provided with proof that staff spread rumors about C1. Based on interviews, observations and file review conducted, 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.


Continued on LIC 9099-C
NAME OF LICENSING PROGRAM MANAGER: Fernando Fierros
NAME OF LICENSING PROGRAM ANALYST: Jose Villalobos
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 12/19/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/19/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 28-AS-20231211102703
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: 12/19/2023
NARRATIVE
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In regards to the allegation "Staff refusing to repair physical plant" it was alleged that C1's room has a broken outlet that staff refuses to fix. (6) of (6) Staff interviewed denied the allegation. (7) of (7) Clients interviewed could not corroborate the allegation. Staff interviewed denied any knowledge of any outlets being broken in C1's room. Staff stated that when they are aware of things that need to be fixed, the maintenance staff will work on it as soon as they can and they do not refuse to fix things. Interview with C1 shows that they believed their outlets were broken at some point but realized that the cables were the issue and not the outlet. C1 stated they did not report this to staff. LPA observed C1's room during the visit and observed that the electrical outlets in C1's room were all functioning. Based on interviews, observations and file review conducted, 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.

In regards to the allegation "Staff is threatening to evict client, due to complaints" it was alleged that S1 threatened to evict C1 due to their complaints. (6) of (6) Staff interviewed denied the allegation. (6) of (7) Clients interviewed could not corroborate the allegation. Interviews conducted do not show that S1 has threatened any clients in care with eviction. LPA was not provided with proof that S1 threatened C1 with an eviction for any reason. S1 denied ever doing that. LPA did not observe any documentation regarding eviction of C1 on file. Based on interviews, observations and file review conducted, 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 conducted and a copy of this report was provided.
NAME OF LICENSING PROGRAM MANAGER: Fernando Fierros
NAME OF LICENSING PROGRAM ANALYST: Jose Villalobos
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 12/19/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/19/2023
LIC9099 (FAS) - (06/04)
Page: 3 of 3