198602244-5-2-2025-28-AS-FFIS-DJD2UN-20250707174234

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198602244
Report Date: 05/02/2025
Date Signed: 05/02/2025 03:07:46 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK ASC, 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
01/14/2025 and conducted by Evaluator Sanjay Vaid

COMPLAINT CONTROL NUMBER: 28-AS-20250114112536

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: 80	DATE:	05/02/2025
		UNANNOUNCED	TIME BEGAN:	08:50 AM
MET WITH:	Administrator-Ruby Garcia		TIME COMPLETED:	03:30 PM

ALLEGATION(S):

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Staff did not prevent clients from using illegal drugs
Staff did not prevent clients from engaging in inappropriate behaviors
Staff hit client
Staff are not properly sanitizing
Staff did not prevent client from having access to hazardous chemicals
Staff inappropriately dumped trash on client's bed

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Vaid made a subsequent visit to the facility of deliver finds to the mentioned allegations. LPA met with Ruby Garcia, Administrator and discussed the purpose of the visit. LPA Vaid toured the facility with Administrator and did not observe any health and safety concerns.

On 01/16/25, Licensing Program Analyst (LPA) Vaid conducted an Initial 24 hour complaint investigation regarding the above allegations. LPA was met by Clarissa Basto Medication Supervisor and Jennifer Tapia Direct Care Staff. LPA discussed the purpose if the visit. Administrator arrived a short time later and assisted with visit.
Investigation consisted of the following: interview of Staff #1 - Staff #5 (S1-S5); interviews of clients from client#1 through client #9 (C1-C9); requested, obtained and reviewed client #1 (C1) face sheet, needs and services. LPA obtained copies of the staff and client rosters, and seven (7) random clients face sheets and needs and services. LPA interviewed three (3) additional staff. Continued on 9099C.......

Unsubstantiated

Estimated Days of Completion:

NAME OF LICENSING PROGRAM MANAGER: Fernando Fierros
NAME OF LICENSING PROGRAM ANALYST: Sanjay Vaid
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 05/02/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/02/2025

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-20250114112536

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK ASC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754

FACILITY NAME: PASADENA ADULT LIVING CENTER	FACILITY NUMBER: 198602244
	VISIT DATE: 05/02/2025

NARRATIVE

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Regarding the allegation: Staff did not prevent clients from using illegal drugs. It is alleged that the assisted living facility staff are not stopping clients from using illegal drugs in the facility. Eight (8) out of eight (8) staff interviewed deny this allegation. Staff stated the facility is an assisted living arrangement with independent adults. The facility does not provide 1:1 service to the clients. Staff can only direct and re-direct the clients’ behaviors. The house rules clearly states, “No Smoking”, and ABSOLUTELY NO Drugs and Alcohol are allowed on the premises. The clients are constantly reminded by staff to smoke cigarettes outside in smoking designated areas, with “No Smoking” signs posted around the facility. Staff acknowledge, clients that use illegal drugs, get high in private, away from the facility and returned to the facility intoxicated. When staff smell funny smoke, they investigate. When clients are caught with illegal substances an internal investigation is conducted and reported to local police and licensing. Staff encourages clients with drug use the Impact Services to help clients with their drug use and issues. Seven (7) out of nine (9) clients interviewed stated they are aware of other clients using illegal drugs, from the smell outside on the sidewalk and alleyways. The drugs are used in private, hidden from the staff away from facility. Residents acknowledge breaking house rules could cause eviction and have strong cravings. Clients acknowledge the Impact Services for drug rehab offered by the facility. Based on record review, interviews conducted, and observations made. 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 the allegation: Staff did not prevent clients from engaging in inappropriate behaviors. It is alleged that the facility staff are not stopping clients from acting with non-conforming behaviors. It is alleged that clients are eating off the floor and staff is encouraging the behavior. Eight (8) out of eight (8) staff interviewed deny this allegation. Staff stated the clients that engage in inappropriate behaviors are monitored and actions of the clients are noted in clients progress reports. The staff directs and sometimes need to re-direct challenging clients from engaging inappropriate and harmful behaviors. Eight (8) out of nine (9) clients interviewed could not corroborate this allegation. Four (4) clients interviewed stated clients occasionally make loud noises and say strange comments, the staff intervenes and re-directs. Based on record review, interviews conducted, and observations made. 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 9099C.......

NAME OF LICENSING PROGRAM MANAGER: Fernando Fierros
NAME OF LICENSING PROGRAM ANALYST: Sanjay Vaid
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 05/02/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/02/2025

LIC9099 (FAS) - (06/04)

Page: 2 of 4

Control Number 28-AS-20250114112536

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK ASC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754

FACILITY NAME: PASADENA ADULT LIVING CENTER	FACILITY NUMBER: 198602244
	VISIT DATE: 05/02/2025

NARRATIVE

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Regarding the allegation: Staff hit client. It is alleged that staff ran up to client and slapped food item from clients’ hand. Eight (8) out of eight (8) staff interviewed deny this allegation. Staff interviewed stated, that does not happen here, the staff will engage in verbal direction and re-direction with moderate tone until client complies. During a group session client engaged in inappropriate behaviors with other clients and attempted to snatch food items from others food plates, when staff attempted to re-direct, client became hostile and confrontational. Eight (8) out of nine (9) clients interviewed could not corroborate this allegation. The clients in the group session were interviewed, clients did not see the staff hit client only re-directed the client and client became angry. Based on 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 is unsubstantiated.

Regarding the allegation: Staff are not properly sanitizing. It is alleged that the facility staff is not sanitizing the facility properly. Staff are not sanitizing their hands when dispensing medications and are placing germs inside the medicine cups. Food staff are serving meals to residents with their bodily fluids. Eight (8) out of eight (8) staff interviewed deny this allegation. Medication staff stated they wear gloves when handling and administering medications to clients. Housekeeping staff stated they clean rooms and are constantly cleaning high touch common areas with cleaning agents. Housekeeping staff clean the rooms daily, dusting, mopping and wiping with sanitary cleaning products, masks and gloves are used. Dining staff state they wear gloves, masks and hairnets, when preparing and serving the food. LPA observed housekeeping and dining staff wiping common areas like dining tables after each use, cleaning doorknobs and handles, wearing gloves, masks and hairnets during the performance of their duties. Eight (8) out of nine (9) clients interviewed could not corroborate this allegation. Clients interviewed state housekeeping keeps their rooms clean smelling nice they use cleaning products and gloves when cleaning. Med-tech wear gloves and masks when administering the medications. Dining staff serves meals wearing masks, gloves and hairnets and cleaning the dining areas. Based on interviews conducted, and observations made. 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 9099C............

NAME OF LICENSING PROGRAM MANAGER: Fernando Fierros
NAME OF LICENSING PROGRAM ANALYST: Sanjay Vaid
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 05/02/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/02/2025

LIC9099 (FAS) - (06/04)

Page: 3 of 4

Control Number 28-AS-20250114112536

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK ASC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754

FACILITY NAME: PASADENA ADULT LIVING CENTER	FACILITY NUMBER: 198602244
	VISIT DATE: 05/02/2025

NARRATIVE

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Regarding the allegation: Staff did not prevent client from having access to hazardous chemicals. It is alleged that staff did not prevent the client from having access to cleaning products and causing injury to themselves by having access to the cleaning solutions closet. Per the allegation, alleges staff sprayed two cleaning products together and made their eyes burn from the smell. Eight (8) out of eight (8) staff interviewed deny this allegation. Housekeeping staff interviewed, the closet for the cleaning products is always kept locked. The only access to the cleaning closet is by management and housekeeping keys. The mobile cleaning carts have locked box to keep cleaning solutions away from clients. Nine (9) out of nine (9) clients interviewed could not corroborate this allegation. Closet keys are kept by the maintenance and housekeeping staff. Clients could not name the cleaning products used to cleaning their room, clients do not recall making this allegation. LPA observed the cleaning solutions closet locked on today visit. Based on interviews conducted, and observations made. 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 the allegation: Staff inappropriately dumped trash on client's bed. It is alleged that a staff person dumped trash onto clients’ bed. Eight (8) out of eight (8) staff interviewed deny this allegation. Housekeeping staff has set duties performed in each room, cleaning the rooms and bathrooms daily, linens are changed weekly depending on the soiled linens. Housekeeping staff stated there are some clients that do not cooperate with housekeeping and other clients that do cooperate with staff and cleaning. Dumping trash onto client’s bed has never occurred according to the housekeeping staff, according to housekeeping they would have to clean the mess in the rooms created by the clients. Housekeeping staff claim they keep the facility clean daily. Eight (8) out of nine (9) clients interviewed could not corroborate this allegation and have no knowledge. Based on interviews conducted, and observations made. 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 was conducted with Administrator, Ruby Garcia. A copy of the report was issued.

Conducted exit interview with Jennifer Tapia, DSP. A copy of the amendment was issued.

NAME OF LICENSING PROGRAM MANAGER: Fernando Fierros
NAME OF LICENSING PROGRAM ANALYST: Sanjay Vaid
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 05/02/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/02/2025

LIC9099 (FAS) - (06/04)

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