198602245-2-8-2024-28-AS-DSIS-D2EUGB-20240213143404

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198602245
Report Date: 02/08/2024
Date Signed: 02/08/2024 01:24:33 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
01/26/2023 and conducted by Evaluator Bennette Pena

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20230126151309

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: 16	DATE:	02/08/2024
		UNANNOUNCED	TIME BEGAN:	10:08 AM
MET WITH:	Rosalie Sandoval - Administrator		TIME COMPLETED:	01:30 PM

ALLEGATION(S):

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Staff are prohibiting resident from having visitors indoors.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Bennette Pena conducted an unannounced subsequent complaint visit regarding the above allegation. LPA met with Naylet Velazquez, Supervisor and explained the reason for the visit. Shortly after, the Administrator, Rosalie Sandoval arrived and assisted LPA with the visit.

During the initial visit conducted on 02/01/2023, LPA Pena obtained copies of the Resident & Staff Rosters, reviewed Resident #1 (R1's) files such as: Face sheet, Admission's Agreement, Physician's Report, and Appraisal, incident reports, police report which involved S2 and W2 (PR# 23000396 / dated 01/02/2023), interviewed Staff #1 (S1) - Staff #4 (S4), and Resident #1 (R1) - Resident #2 (R2).

During today’s visit, LPA Pena obtained copies of the Resident & Staff Rosters, House Rules, Visitation Policy, Facility’s Visitation Practices and Incident Report (SIR/dated 01/05/2023). LPA reviewed Resident #1 (R1's) files such as: Face sheet, Admission's Agreement, Physician's Report, and Appraisal/Needs and Services Plan. LPA also reviewed PIN 22-28.1-ASC (issued 11/29/2022), interviewed Resident #3 (R3) - Resident #10 (R10) and re-interviewed Staff #1 (S1) - Staff #3 (S3). *****CONTINUED ON LIC9099-C*****

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: David Sicairos	TELEPHONE: (323) 981-3982
LICENSING EVALUATOR NAME: Bennette Pena	TELEPHONE: (323) 981-3307
LICENSING EVALUATOR SIGNATURE:	DATE: 02/08/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/08/2024

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-20230126151309

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: GARFIELD VILLAS LLC	FACILITY NUMBER: 198602245
	VISIT DATE: 02/08/2024

NARRATIVE

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The investigation revealed the following:

In regards to the allegation: “Staff are prohibiting resident from having visitors indoors.” It is alleged that a resident is not allowed to have visitors inside the facility. Interviews conducted with the staff denied the allegation and stated that they are aware of resident rights regarding visitation. Staff interviewed stated that facility allows indoor visits however, visitors are required to go through covid screening and wear a mask upon entering to protect the residents in the facility. Staff interviewed indicated that they did not restrict visitors of any residents nor require an appointment to visit. (4) of (4) staff interviewed indicated that R1’s family members refused to be screened nor follow the facility's visitation policy. Staff stated they still allowed R1's family members to come in and just asked them to follow covid guidelines. S1 stated that the visiting requirements were explained to R1. (9) out of (10) residents interviewed stated that they are allowed to have visitors indoors during visiting hours and the facility does not restrict their visitation rights. Residents indicated that the staff conducted covid screening, signing in and checking temperatures before letting visitors in. LPA observed the visiting policy posted on the door and is accessible to residents and families. LPA did not observe any documents or evidence in R1's file indicating that the facility is restricting visitation from certain individuals or family members. LPA reviewed documents such as facility's best practices for visitation and CCLD Provider Information Notice (PIN 22-28.1-ASC), issued on Nov 29, 2022 regarding best practices for visitation. Documents reviewed stated that licensees should follow the strictest requirements, encourage shorter indoor visits and longer outdoor visits and recommended screening for COVID-19 signs, symptoms, and exposure for visitors. Additionally, a well-fitting face mask was required for visitors at all times in indoor settings, regardless of vaccination status. Based on statements and interviews conducted with residents and staff as well as reviewed files and documentation, there was not enough supportive evidence to corroborate the allegation.

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 and a copy of this report was provided to Rosalie Sandoval, Administrator.

SUPERVISOR'S NAME: David Sicairos	TELEPHONE: (323) 981-3982
LICENSING EVALUATOR NAME: Bennette Pena	TELEPHONE: (323) 981-3307
LICENSING EVALUATOR SIGNATURE:	DATE: 02/08/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/08/2024

LIC9099 (FAS) - (06/04)

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