198602244-5-31-2024-28-AS-RORN-D5XULV-20240605154121

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198602244
Report Date: 05/31/2024
Date Signed: 05/31/2024 03:05:44 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
05/28/2024 and conducted by Evaluator Alberto Lopez

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20240528141852

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: 88	DATE:	05/31/2024
		UNANNOUNCED	TIME BEGAN:	09:37 AM
MET WITH:	Ruby Garcia, Administrator		TIME COMPLETED:	03:19 PM

ALLEGATION(S):

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Facility staff are financially abusing client in care
Client is being sexually harassed in facility
Client not being accorded dignity and respect in relationship with staff

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Alberto Lopez made unannounced visit to investigate the above allegations. LPA met with Clarissa Basto, Medication Supervisor and Administrator Ruby Garcia arrived a short time later and assisted with the visit.

The investigation consisted of the following: LPA took tour of facility common areas and random rooms, LPA interviewed Six (6) staff and nine (9) residents. LPA reviewed and obtained staff and resident rosters. C1 Physician's Report for Community Care Facilities, C1 Face Sheet, C1 Appraisal/Needs and Services Plan.

Allegation: Facility staff are financially abusing client in care. It is alleged that facility is withholding one (1) million dollars of resident’s money.

(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: 05/31/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/31/2024

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-20240528141852

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: 05/31/2024

NARRATIVE

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The investigation revealed: LPA interviewed six (6) staff and six (6) of six (6) staff denied the allegation. LPA interviewed nine (9) clients and nine (9) of nine (9) clients could not collaborate the allegations. C1 asked LPA to “forget about it, not true” There is not enough evidence to substantiate this allegation.

Allegation: Client is being sexually harassed in facility. It is alleged that R1 is being sexually harassed. LPA interviewed six (6) staff and six (6) of six (6) staff denied the allegation. LPA interviewed nine (9) clients and nine (9) of nine (9) clients could not collaborate the allegations. C1 told LPA “forget about it, not true” Other residents stated they have not observed any sexual harassment at the facility. There is not enough evidence to substantiate this allegation.

Allegation: Client not being accorded dignity and respect in relationship with staff. It is alleged that facility staff is being mean to C1 by dumping dirt in C1 dressers. LPA interviewed six (6) staff and six (6) of six (6) staff denied the allegation. LPA toured C1 room and LPA did not observe any dirt in the dressers or anywhere in the room. LPA interviewed nine (9) clients and nine (9) of nine (9) clients could not collaborate the allegations. All client's interviewed today stated that staff is not mean or throw dirt in their rooms. Clients interviewed today stated staff is respectful and treat clients with dignity. C1 told LPA “forget about it, not true” There is not enough evidence to substantiate this allegation.

Based on observations, and interviews conducted with staff, and clients, 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.

Exit interview conducted and copy of report provided to Administrator.

NAME OF LICENSING PROGRAM MANAGER: Lisa Hicks
NAME OF LICENSING PROGRAM ANALYST: Alberto Lopez
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 05/31/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/31/2024

LIC9099 (FAS) - (06/04)

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