198603286-5-13-2025-28-AS-RORN-DGVUX5-20250521155742

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198603286
Report Date: 05/13/2025
Date Signed: 05/13/2025 11:45:58 AM

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
04/03/2025 and conducted by Evaluator Elizabeth Irra

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20250403094544

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: 57	DATE:	05/13/2025
		UNANNOUNCED	TIME BEGAN:	09:10 AM
MET WITH:	Maria Luisa Razo		TIME COMPLETED:	12:00 PM

ALLEGATION(S):

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Staff did not assist residents with obtaining medical care.
Staff did not ensure residents had access to personal belongings.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Elizabeth Irra conducted a subsequent visit to investigate the above allegations. LPA met with Maria Luisa Razo (Residential Services) and discussed the purpose of this visit.

LPA Irra conducted the initial visit on 04/10/25. During this visit, LPA gained entry to this facility by the contractor. Per Mr. Solorio, there were no staff nor residents present at this location as they have not repopulated back from a sister location (residents were temporarily relocated due to the Eaton Fire). Facility Administrator sent LPA a copy of the staff and resident rosters and documentation pertaining to the above allegations.

During the course of this investigation, LPA Irra interviewed Staff #1 (S-1) through Staff #4 (S-4), interviewed Resident #1 (R-1) through Resident #6 (R-6), obtained medical appointment calendars for February 2025 through April 2025 (for resident medical appointments including transportation) and staff notes pertaining to retrieving personal belongings for residents. **Refer to LIC 9099C for the continuation of this report.**

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Tony Vasallo
LICENSING EVALUATOR NAME: Elizabeth Irra
LICENSING EVALUATOR SIGNATURE:	DATE: 05/13/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/13/2025

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-20250403094544

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: 05/13/2025

NARRATIVE

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Allegation: Staff did not assist residents with obtaining medical care. It has been alleged that there were on-going issues with residents not being provided transportation to medical appointments since the temporary relocation. Staff interviews revealed that staff assisted residents with their medical appointments including coordinating round trip transportation services from the temporary relocation to residents’ medical appointments. Per staff interviews, transportation services were coordinated with the residents’ pertaining medical insurance companies. Interviewed staff indicated that a Town Hall meeting was held in February 2025 to discuss this matter. Interviewed staff indicated that they did not receive complaints/concerns pertaining to this matter. Resident interviews revealed that staff assisted residents with scheduling medical appointments and coordinating round trip transportation services. Interviewed residents indicated they did not have any concerns pertaining to this matter. Interviews and documentation do not corroborate this allegation.

Allegation: Staff did not ensure residents had access to personal belongings. It has been alleged that residents were not able to access their personal belongings that were left at this facility when residents were relocated. Staff interviews revealed that staff retrieved residents’ personal belongings (upon request from residents) and would retrieve mail once per week at this facility. Interviewed staff indicated that staff would retrieve the items without the residents present due to this facility undergoing construction (due to safety purposes). Interviewed staff indicated that a Town Hall meeting was held in February 2025 to discuss this matter. Interviewed staff indicated that they did not receive complaints/concerns pertaining to this matter. Resident interviews revealed that staff retrieved residents’ personal belongings upon request. Interviewed residents indicated they did not have any concerns pertaining to this matter. Interviews and documentation do not corroborate this allegation.

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 conducted, appeal rights and a copy of this report was provided to Maria Luisa Razo.

SUPERVISORS NAME: Tony Vasallo
LICENSING EVALUATOR NAME: Elizabeth Irra
LICENSING EVALUATOR SIGNATURE:	DATE: 05/13/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/13/2025

LIC9099 (FAS) - (06/04)

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