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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198602245
Report Date: 06/11/2020
Date Signed: 06/11/2020 12:30:11 PM



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
03/28/2019 and conducted by Evaluator Kruz Long
PUBLIC
COMPLAINT CONTROL NUMBER: 28-AS-20190328130837
FACILITY NAME:GARFIELD VILLAS LLCFACILITY NUMBER:
198602245
ADMINISTRATOR:SANDOVAL, ROSALIEFACILITY TYPE:
740
ADDRESS:1425 N GARFIELD AVETELEPHONE:
(626) 398-3261
CITY:PASADENASTATE: CAZIP CODE:
91104
CAPACITY:40CENSUS: 30DATE:
06/11/2020
UNANNOUNCEDTIME BEGAN:
11:30 AM
MET WITH:Rosalie Sandoval (Administrator)TIME COMPLETED:
12:00 PM
ALLEGATION(S):
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Facility staff financially abused the resident.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Kruz Long called the facility for the purpose of delivering complaint findings for the allegation listed above. Due to the situation surrounding the Coronavirus Disease 2019 (COVID-19), and to implement mitigation measures, LPA spoke with Rosalie Sandoval (Administrator) telephonically.

During the initial complaint investigation conducted on 04/04/19, LPA obtained a copy of the staff/resident roster, reviewed and obtained a copy of the facility financial records and Resident #1's records and interviewed Staff #1 in the office at 11:00 am. Continue to LIC9099C.........

Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Fernando FierrosTELEPHONE: (323) 981- 3981
LICENSING EVALUATOR NAME: Kruz LongTELEPHONE: (323) 383-8117
LICENSING EVALUATOR SIGNATURE:

DATE: 06/11/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/11/2020
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-20190328130837
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: GARFIELD VILLAS LLC
FACILITY NUMBER: 198602245
VISIT DATE: 06/11/2020
NARRATIVE
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The complaint investigation is as followed: Review of resident #1 records which include the following documents; Resident #1 Admissions Agreements for both the former and current licensees, bank statements, copy of checks, facility invoices for client #1 payment history, indicate that resident #1 was admitted to facility, Garfield Villas, on 07/13/18 and was discharged from the facility in November 2018. Prior to being admitted to the facility, resident #1 was residing at the facility under the former licensee and on 07/13/18, the new owner was licensed as Garfield Villas LLC. Records in resident #1 file, indicate a check payable to “Garfield Villas” was deposited into facility funds for resident #1 on 09/12/16. Review of resident #1 account ledgers for the period 09/12/16 through November 2018 did not reveal that the facility was financially abusing client #1 funds. On 03/11/19, the facility processed payment to Social Security Administration for resident #1 remaining balance, however, review of records, indicate resident #1 has an outstanding balance in the amount of $278.67. Therefore, based upon the information obtained during the investigation, the facility owes resident #1 the sum of $278.67, however, there is no evidence to support that the facility was abusing resident # 1 finances.

Based on LPA's interview and record review, investigation revealed: 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.

A telephonic exit interview was conducted with Rosalie Sandoval and a hard copy was provided via email for signature.
SUPERVISOR'S NAME: Fernando FierrosTELEPHONE: (323) 981- 3981
LICENSING EVALUATOR NAME: Kruz LongTELEPHONE: (323) 383-8117
LICENSING EVALUATOR SIGNATURE:

DATE: 06/11/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/11/2020
LIC9099 (FAS) - (06/04)
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