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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198602244
Report Date: 10/13/2021
Date Signed: 10/13/2021 03:57:38 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
10/04/2021 and conducted by Evaluator Cynthia D Chan
PUBLIC
COMPLAINT CONTROL NUMBER: 28-AS-20211004162744
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: 97DATE:
10/13/2021
UNANNOUNCEDTIME BEGAN:
09:15 AM
MET WITH:Clarissa Basto, StaffTIME COMPLETED:
04:00 PM
ALLEGATION(S):
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Staff spoke inappropriately about client.
Staff did not safeguard client's personal belongings.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Cynthia Chan conducted an investigation regarding the allegations listed above. LPA arrived unannounced and met with Staff, Clarissa Basto. The reason for the visit was explained. Administrator, Ruby Garcia, arrived shortly thereafter to assist with the visit.

The investigation consisted of the following:
LPA Chan obtained a copy of the staff roster, client roster, and staff training logs. LPA interviewed the Administrator, 4 Staff, and 11 Clients and reviewed clients' files.

The investigation revealed the following:
Regarding allegation - Staff spoke inappropriately about client. It is alleged that staff has been spreading rumors about Client #1 (C1). Administrator Garcia is aware of Client #1 making these accusations and also stated that client makes accusations often. Per Staff interviews, they denied spreading any rumors nor making inappropriate comments about C1 and have not heard any other staff doing so.
Unsubstantiated
Estimated Days of Completion:
NAME OF LICENSING PROGRAM MANAGER: Lisa Hicks
NAME OF LICENSING PROGRAM ANALYST: Cynthia D Chan
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 10/13/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/13/2021
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-20211004162744
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: 10/13/2021
NARRATIVE
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They stated they treat clients nicely and respectfully. LPA interviewed a total of 11 Clients today. Three (3) of them indicated that not all the staff treat them well and had made inappropriate remarks toward them. The rest of the clients interviewed have not heard of any staff spreading any rumors or saying inappropriate things about clients.

Regarding allegation - Staff did not safeguard client's personal belongings. Administrator Garcia was made aware that Client #1's personal belongings were stolen by a housekeeper. Per Administrator, Client #1 had made accusations of such in the past but there were no proof. LPA reviewed C1's Personal Property and Valuables form and did not see any personal items listed on the form. The housekeepers interviewed denied stealing clients' belongings. They stated they do not take or throw away any belongings of client. When they clean, they would clean around their belongings. The only things they would throw out are dirty cups and rotten food as instructed by the Administrator in order to avoid pests. According to the interviews with clients, five (5) of them have stated their personal belongings were stolen or missing. Based on interviews conducted, there is insufficient evidence to corroborate this allegation.

Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are UNSUBSTANTIATED.

An exit interview was conducted with the Administrator. A copy of this report along with the appeal rights were provided.
NAME OF LICENSING PROGRAM MANAGER: Lisa Hicks
NAME OF LICENSING PROGRAM ANALYST: Cynthia D Chan
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 10/13/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/13/2021
LIC9099 (FAS) - (06/04)
Page: 2 of 2