198602244-2-23-2024-28-AS-LHIS-D3HM7N-20240319092143

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198602244
Report Date: 02/23/2024
Date Signed: 02/23/2024 02:09:25 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
02/16/2024 and conducted by Evaluator Alberto Lopez

COMPLAINT CONTROL NUMBER: 28-AS-20240216112029

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: 84	DATE:	02/23/2024
		UNANNOUNCED	TIME BEGAN:	08:53 AM
MET WITH:	Jennifer Tapia and Clarrisa Basto, Ruby Garcia, Administrator		TIME COMPLETED:	02:14 PM

ALLEGATION(S):

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Resident is being harassed by other residents
Facility staff are financially abusing client in care

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Alberto Lopez made an unannounced visit to investigate the above allegations. LPA met with staff Jennifer Tapia and Clarrisa Basto and explained the purpose of the visit. Administrator Ruby Garcia arrived a short time later and assisted with the visit.

The investigation consisted of the following:

LPA interviewed 5 staff including Administrator, S#1-S#5, 10 clients C#1-C#10, reviewed C6 Physician report LIC802, C6 face sheet, and staff and client rosters. LPA took tour of facility. LPA attempted to contact C6 family but was unsuccessful.

The investigation revealed:

(continued on 9099C)

Unsubstantiated

Estimated Days of Completion:

NAME OF LICENSING PROGRAM MANAGER: Lisa Hicks
NAME OF LICENSING PROGRAM ANALYST: Alberto Lopez
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 02/23/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/23/2024

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-20240216112029

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: 02/23/2024

NARRATIVE

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Regarding Allegation: Resident is being harassed by other residents. It is alleged that some male residents are sexually harassing C6.

LPA interviewed 5 staff and 5 of 5 staff denied the allegation. Some staff stated that C6 has history of fabricating allegations. LPA interviewed 10 clients and 9 of 10 could not collaborate the allegation. C6 provided LPA with names of 3 alleged harassers and LPA interviewed all 3 alleged harassers and all three denied the allegations that they are harassing C6. All 3 stated they do everything to avoid C6. C6 could not identify any witnesses to the harassment during the visit. LPA did not observe any clients harassing any clients or acting inappropriately towards any clients during the visit. There is no evidence that clients are sexually harassing other clients at facility.

Regarding Allegation: Facility staff are financially abusing client in care. It is alleged that facility administrator S5 received a check in the amount of $198 for C6 and it was never given to C6.

LPA interviewed 5 staff and 5 of 5 including Administrator denied the allegation. S5 stated that C6 mother handles C6 money and comes to facility to personally hand her cash every month. On very rare occasions mother of C6 will send a check, when unable to visit facility, for C6 P&I money and that is given to C6 right away. S5 stated she has no record of mother sending a check for $198. C6 stated C6 forgot and probably got the money. C6 stated to LPA during the interview that facility did not owe her anything at this time. 10 of 10 clients interviewed stated that facility does not abuse then financially and do not know of any clients that have been financially abused.

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 rights were issued.

NAME OF LICENSING PROGRAM MANAGER: Lisa Hicks
NAME OF LICENSING PROGRAM ANALYST: Alberto Lopez
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 02/23/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/23/2024

LIC9099 (FAS) - (06/04)

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