198603286-12-7-2023-28-AS-RORN-CZ6V96-20240104151348

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198603286
Report Date: 12/07/2023
Date Signed: 12/07/2023 03:20:15 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
12/04/2023 and conducted by Evaluator Luis Mora

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20231204104639

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: 76	DATE:	12/07/2023
		UNANNOUNCED	TIME BEGAN:	09:09 AM
MET WITH:	Alexander Solorio - Assistant Administrator		TIME COMPLETED:	03:35 PM

ALLEGATION(S):

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Staff did not safeguard resident's personal belongings.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Luis Mora conducted an unannounced complaint visit regarding the above allegations. LPA met with Alexander Solorio (Assistant Administrator) and explained the reason for the visit.

The investigation consisted of the following: LPA Mora obtained copies of staff & resident rosters, and interviewed Assistant Administrator, Staff 1, and Resident 1 - Resident 8 (R1 - R8). LPA also reviewed R1's Record of Client's/Resident's Safeguard Cash Resources.

The investigation revealed the following: regarding the allegation "staff did not safeguard resident's personal belongings, it is alleged that a staff stole $200 and a bag from a resident's room. Assistant Administrator and staff denied the allegation. Assistant Administrator showed the LPA a lobby video footage of a staff giving Resident 1 (R1) P&I money. The video footage has a date and time of Friday (12/01/23) at 9:21am and per R1's Record of Client's/Resident's Safeguard Cash Resources a total of $200 was given to R1 on 12/01/23. After receiving the money the resident was out in the community all dat Friday 12/01/23.
(Continued to LIC 9099-C)

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Wei Siew Ho	TELEPHONE: (323) 981-3969
LICENSING EVALUATOR NAME: Luis Mora	TELEPHONE: 323-981-3964
LICENSING EVALUATOR SIGNATURE:	DATE: 12/07/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/07/2023

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-20231204104639

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: PASADENA VILLA SENIOR LIVING	FACILITY NUMBER: 198603286
	VISIT DATE: 12/07/2023

NARRATIVE

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Assistant Administrator stated that on Sunday 12/03/23, R1 called the police to report theft and R1 accused Staff 1 (S1). He also stated that the bag was found in R1's room on 12/04/2023. LPA interviewed S1 and S1 denied stealing any money or a bag from R1. Information provided by the Pasadena Police Department stated that on Sunday 12/03/23 at 6:00pm they responded to this facility regarding a resident calling to report that he/she was a victim of a theft and the resident suspected S1. Resident told the police that he/she was missing money ($200.00) and a bag from his/her room. However, the resident did not have any evidence to prove that S1 took the items and the police officer was not able to locate any independent witnesses. LPA interviewed R1 and R1 denied calling the police on 12/03/23, and R1 stated that the money was not stolen over the weekend and that it happened Thursday 11/30/23 at night when he asked S1 to help him/her take out a laptop and other things from R1's backpack where he/she had the money (however, the $200 were given to R1 on the morning of Friday 12/01/23). R1 stated every night he/she will ask staff to help him/her take out things from his/her backpack because he/she has no hands. R1 denied receiving the $200 on Friday 12/01/23 and stated that the $200 were given to him/her on the morning of Thursday 11/30/23. R1 also stated that he/she was at school all day on Friday 12/01/23 and got back to the facility around 7pm and that is when R1 realized that the money was missing and he/she complained to the Assistant Administrator and staff. R1 stated that none of his/her bags were stolen only the money. The other 7 residents interviewed could not corroborate with the allegation and they all stated that staff have not stolen from them.

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.

Exit interview held and a copy of the report was provided

SUPERVISOR'S NAME: Wei Siew Ho	TELEPHONE: (323) 981-3969
LICENSING EVALUATOR NAME: Luis Mora	TELEPHONE: 323-981-3964
LICENSING EVALUATOR SIGNATURE:	DATE: 12/07/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/07/2023

LIC9099 (FAS) - (06/04)

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