198602245-4-6-2021-28-AS-MVAO-BZZTY8-20210412150818

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198602245
Report Date: 04/05/2021
Date Signed: 04/06/2021 10:53:51 AM

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
09/03/2020 and conducted by Evaluator Christine Wong

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20200903091116

FACILITY NAME:	GARFIELD VILLAS LLC		FACILITY NUMBER:	198602245
ADMINISTRATOR:	SANDOVAL, ROSALIE		FACILITY TYPE:	740
ADDRESS:	1425 N GARFIELD AVE		TELEPHONE:	(626) 398-3261
CITY:	PASADENA	STATE: CA	ZIP CODE:	91104
CAPACITY:	40	CENSUS: 25	DATE:	04/05/2021
		UNANNOUNCED	TIME BEGAN:	09:50 AM
MET WITH:	Rosalie Sandoval		TIME COMPLETED:	10:30 AM

ALLEGATION(S):

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Staff failed to adequately supervise residents
Staff failed to meet residents' care needs
Staff member interrupts resident's sleep

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Christine Wong initiated a subsequent complaint investigation for the allegations listed above. Due to the situation surrounding the Coronavirus Disease 2019 (COVID-19), and to implement mitigation measures, today’s complaint investigation was conducted telephonically with Administrator Rosalie Sandoval.

The investigation consisted of the following: On 09/10/20, LPA conducted the initial 10 days complaint visit and interviewed administrator, three staff (S1-S3) and one resident (R1). LPA also obtained staff and resident roster and incident report for Resident#2 (R2). On 09/11/20, LPA also interviewed additional two residents.

The investigation revealed of the following: Allegation#1 “Staff failed to adequately supervise residents.” Based on the interviews with residents, residents reported that all the staff have adequately supervised them, and staff would conduct the room check 2-3 times at night.
(See LIC9099C for continuation)

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Christine Yee	TELEPHONE: (323) 981-3978
LICENSING EVALUATOR NAME: Christine Wong	TELEPHONE: (323) 981-3963
LICENSING EVALUATOR SIGNATURE:	DATE: 04/05/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/05/2021

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-20200903091116

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: 04/05/2021

NARRATIVE

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Staff reported that they usually have two staff for night shift, and they will rotate to conduct the room check every two hours. LPA also reviewed the log sheet for room check which staff conducted the room check every two hours for residents. LPA also reviewed the incident report for R2, there’s no direct witness to R2’s fall.

Allegation#2 “Staff failed to meet residents' care needs.” Based on the interview with residents and they all reported staff can meet their care needs and they are nice to them. All staff reported they never heard any complaints from residents regarding the allegation. And they always tried their best to meet the residents needs and provide help when residents needed.

Allegation#3 “Staff member interrupts resident's sleep.” LPA interviewed three residents and two of the residents reported they had never seen any staff members slept at night and no staff member were snored at night and interrupt residents' sleep. LPA interviewed three staff and all staff denied the allegation and stated they had never seen any staff slept and snored during the night shift and interrupted residents’ sleep. Administrator reported staff only rest during their break time but not during their work.

Based on statements and interviews conducted with residents and staff and there was not enough supportive evidence to concur with the reported allegations. Although the allegations may have happened or are valid, there are not a preponderance of evidence to prove the alleged violations did or did not occur, therefore all the allegations are UNSUBSTANTIATED.

A telephonic exit interview was conducted with Administrator Rosalie Sandoval. A hard copy of the report was emailed. Staff was instructed to sign the LIC 9099 reports and return to LPA.

SUPERVISOR'S NAME: Christine Yee	TELEPHONE: (323) 981-3978
LICENSING EVALUATOR NAME: Christine Wong	TELEPHONE: (323) 981-3963
LICENSING EVALUATOR SIGNATURE:	DATE: 04/05/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/05/2021

LIC9099 (FAS) - (06/04)

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