198603286-9-3-2020-28-AS-MVAO-BTJNMX-20200917103548

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198603286
Report Date: 09/02/2020
Date Signed: 09/03/2020 08:08:33 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
07/31/2020 and conducted by Evaluator Christine Wong

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20200731165417

FACILITY NAME:	PASADENA VILLA SENIOR LIVING		FACILITY NUMBER:	198603286
ADMINISTRATOR:	MURPHY, MICHAEL		FACILITY TYPE:	740
ADDRESS:	1811 N. RAYMOND AVE		TELEPHONE:	(626) 791-6232
CITY:	PASADENA	STATE: CA	ZIP CODE:	91103
CAPACITY:	97	CENSUS: 43	DATE:	09/02/2020
		UNANNOUNCED	TIME BEGAN:	02:40 PM
MET WITH:	Alexander Solorio-Assistant Administrator		TIME COMPLETED:	03:20 PM

ALLEGATION(S):

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Facility threatened resident with eviction
Facility staff do not answer resident's call button in a timely manner
Facility staff are not assisting resident with needs
Facility staff speak inappropriately to resident

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Christine Wong conducted a subsequent complaint investigation visit 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 Assistant Administrator Alexander Solorio and the purpose of the call was discussed.

The investigation consisted of the following: during the initial visit conducted on 08/06/20, LPA interviewed two staff (S1 and S2) and two residents (R2 and R3), R1 was refused to interview. LPA also obtained R1's Identification and Emergency Information, admission agreement, physician report and needs and service plan. On 08/17/20 and 08/19/20, LPA interviewed three residents (R4-R6) and four staff (S3- S6). On 08/20/2020, R1 responded to LPA via email.

Continued 9099C

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: 09/02/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/02/2020

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-20200731165417

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 VILLA SENIOR LIVING	FACILITY NUMBER: 198603286
	VISIT DATE: 09/02/2020

NARRATIVE

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The investigation revealed of the following: Regarding the allegation#1 “Facility threatened resident with eviction.” It is alleged that resident can be evicted for non-payment. LPA interviewed 6 residents, 5 residents reported staff never threatened them with eviction or any related issues. LPA interviewed 6 staff, all 6 staff reported that they never threatened any residents and staff never gave out an eviction letter to R1. Executive director reported R1 is under a state funded program and R1 required to pay a portion of the rent. The facility staff explained to R1 about the program and handed R1 with the payment notification, then R1 got upset. Therefore, based on the interviews and record review, LPA finds allegation#1 to be UNSUBSTANTIATED.

For the allegation#2 “Facility staff do not answer resident's call button in a timely manner.” It is alleged that some caregivers stopped answering the call light. LPA interviewed 6 residents, 5 residents reported facility staff answered the call button in a timely manner, all the staff are very quick to respond and never delayed. LPA interviewed 6 staff and all 6 staff reported they must respond to the call button between 5 to 10 minutes and they must ensure if it is an emergency or urgent matter for the residents. Therefore, based on the investigation, LPA finds allegation#2 to be UNSUBSTANTIATED.

For the allegation#3 “Facility staff are not assisting resident with needs.” It is alleged that caregivers would ask resident take out the own garbage and go to the kitchen to get a spoon. LPA interviewed 6 residents and 5 residents reported the facility staff can meet their needs and they are all very helpful. LPA interviewed 6 staff and they all reported R1 is independent and only needs stand by assistance with showering and toileting. Staff stated that R1 likes to request assistance constantly through the call button although it’s never urgent which include trash bag changing, requesting a spoon, turning on the television or opening the blind…etc.; staff are still always there to help and assist with R1. Staff also reported when R1 requests something, R1 needs immediately. Therefore, based on the interviews conducted with residents and staff, LPA finds allegation#3 to be UNSUBSTANTIATED.

For the allegation#4 “Facility staff speak inappropriately to resident.” Interviews conducted with 6 residents and 5 residents reported all the facility staff are very nice, understanding and never being mean and speak inappropriately to the residents. All staff were denied being speak inappropriately toward resident and all staff interviewed have received Personal Rights training. Therefore, based on the investigation, LPA finds allegation#4 to be UNSUBSTANTIATED.

SUPERVISOR'S NAME: Christine Yee	TELEPHONE: (323) 981-3978
LICENSING EVALUATOR NAME: Christine Wong	TELEPHONE: (323) 981-3963
LICENSING EVALUATOR SIGNATURE:	DATE: 09/02/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/02/2020

LIC9099 (FAS) - (06/04)

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Control Number 28-AS-20200731165417

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 VILLA SENIOR LIVING	FACILITY NUMBER: 198603286
	VISIT DATE: 09/02/2020

NARRATIVE

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

A telephonic exit interview was held, and hard copy was provided via email for signature along with appeal rights.

SUPERVISOR'S NAME: Christine Yee	TELEPHONE: (323) 981-3978
LICENSING EVALUATOR NAME: Christine Wong	TELEPHONE: (323) 981-3963
LICENSING EVALUATOR SIGNATURE:	DATE: 09/02/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/02/2020

LIC9099 (FAS) - (06/04)

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