198603286-10-6-2021-28-AS-WSHO-C8M29J-20211109161158

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198603286
Report Date: 10/06/2021
Date Signed: 10/06/2021 03:35:17 PM

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
12/01/2020 and conducted by Evaluator Luis Mora

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20201201103928

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: 44	DATE:	10/06/2021
		UNANNOUNCED	TIME BEGAN:	08:30 AM
MET WITH:	Alexander Solorio - Assistant Administrator		TIME COMPLETED:	12:00 PM

ALLEGATION(S):

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Facility made false claims regarding employee training.
Staff have not received required training.

INVESTIGATION FINDINGS:

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

The investigation consisted of the following: LPAs obtained copies of Staff & Client Rosters, Staff #1 - #5 (S1-S5) New Hire Initial Training Record sheet and Hands-on Training Record sheet. LPA Mora interviewed Assistant Administrator Alexander Solorio and S1 - S5.

The investigation revealed the following: in regards to the allegation "facility made false claims regarding employee training.", it is alleged that the assistant administrator Alexander Solorio signed caregivers training certificates, however, the caregivers never actually received the training. LPA Mora observed CPR/First Aid certificates for S1 - S5. (CONTINUED ON LIC 9099C)

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Rebecca Orendain	TELEPHONE: (323) 981-3961
LICENSING EVALUATOR NAME: Luis Mora	TELEPHONE: 323-981-4934
LICENSING EVALUATOR SIGNATURE:	DATE: 10/06/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/06/2021

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-20201201103928

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: 10/06/2021

NARRATIVE

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LPA Mora also observed that S1 - S5 completed 40 hours of initial training which included Orientation, Building and Fire Safety, Dementia Care, Medication Policies and Procedures, Personal Care/Universal Precautions/ Postural Supports, Restricted Conditions, Hospice/Psychosocial Need/Direct Care. These trainings are listed on the New Hire Initial Training Record and Hands-on Training Record and signed by the Assistant Administrator Alexander Solorio. Per interviews with caregivers, 5 out of 5 confirmed that they completed these training at the beginning of their employment. Therefore, there was insufficient evidence to corroborate with the allegation.

In regards to the allegation "staff have not received required training.", it is alleged that the training that the caregivers receive at the facility is merely shadowing a day or two and do not get computer, classroom or video training. Complainant stated that the new caregivers have mentioned that they do not know what they are doing and are feeling lost in their job. LPA Mora observed that on the New Hire Initial Training Record sheet, the method of training used was a combination of media and shadowing. Per interviews with caregivers, 5 out 5 confirmed that they received training via media for about 3-4 days and then shadowing for 3 days. Furthermore, none of the caregivers indicated that they felt lost at their job and stated that they received proper training and continue to get refresher and new training every 3 months. Therefore, there was insufficient evidence to corroborate with the allegation.

Based on statements and interviews conducted with staff and review of staff training records, 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 violations did or did not occur, therefore the allegations are UNSUBSTANTIATED.

Exit interview was held with Assistant Administrator Alexander Solorio and a copy of this report was provided.

SUPERVISOR'S NAME: Rebecca Orendain	TELEPHONE: (323) 981-3961
LICENSING EVALUATOR NAME: Luis Mora	TELEPHONE: 323-981-4934
LICENSING EVALUATOR SIGNATURE:	DATE: 10/06/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/06/2021

LIC9099 (FAS) - (06/04)

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