198603286-3-28-2024-28-AS-RORN-D4LMCR-20240423092959

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198603286
Report Date: 03/28/2024
Date Signed: 03/28/2024 12:01:52 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
03/22/2024 and conducted by Evaluator Bennette Pena

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20240322134755

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: 83	DATE:	03/28/2024
		UNANNOUNCED	TIME BEGAN:	09:00 AM
MET WITH:	Alexander Solorio - Assistant Administrator		TIME COMPLETED:	12:10 PM

ALLEGATION(S):

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Staff did not treat residents with respect.
Residents' personal belongings are missing.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Bennette Pena conducted an initial complaint visit to investigate the
above allegations. LPA met with Alexander Solorio, Assistant Administrator and explained the purpose of the visit.
The investigation consisted of the following: LPA obtained copies of the Staff roster, Resident roster,
Staff In-service Training about Personal Rights, Residents Rights and Zero Tolerance Policy. LPA conducted a facility tour of the common areas. LPA interviewed Staff #1 (S1) – Staff #5 (S5) and Resident #1
(R1) – Resident #8 (R8).
In regards to the allegation: “Staff did not treat residents with respect.” It is alleged that staff have been entering the residents’ room and disrespecting them for the last 3 months. No additional details given. Interviews conducted with staff members revealed that they treat all residents with dignity and respect. (5) out of (5) staff members interviewed stated that they never heard or witnessed any staff entering the residents’ room without knocking and without resident’s permission. S1 stated that they have all staff meeting on a monthly basis to discuss reported problems, issues and concerns in the facility. ****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: 03/28/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/28/2024

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-20240322134755

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: 03/28/2024

NARRATIVE

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(5) out of (5) staff members stated that they receive training such as personal rights, residents rights and zero tolerance policy regularly. R1-R2 denied the allegation and stated that they did not file a complaint. (8) out of (8) residents that were interviewed stated that staff members treat them with dignity and respect. Interviewed residents stated that staff knock before coming into their rooms, even if the door is open. All interviewed residents stated that they don't have any problem with staff, that staff are nice and respectful. During the tour, LPA did not not observe staff speaking inappropriately or disrespectful to residents. Based on statements and interviews conducted with residents and staff as well as reviewed files, there was not enough supportive evidence to corroborate the allegation.

Allegation: "Residents' personal belongings are missing." It is alleged that staff have been stealing the residents’ personal belongings for the last 3 months. No additional details given. Staff interviews revealed that staff are not entering clients’ rooms without permission and stealing the residents’ personal belongings. S1 stated that the facility has zero tolerance policy with that type of behavior and that residents’ rights in service training are being conducted to staff members regularly. Staff interviews revealed that staff have not received any complaints nor have received any report regarding this matter. R1-R2 denied the allegation and stated that they did not file a complaint. Interviewed residents stated that they have not heard anyone complaining about this matter. Interviews conducted with (8) residents revealed that the facility staff respect their belongings and have never taken any of their belongings. Some residents stated that they do not have any concerns with staff as the staff are good and helpful. Resident and staff interviews do not corroborate this allegation.

Based on statements and interviews conducted with staff, residents and review of facility file 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 conducted and a copy of this report was provided to Alexander Solorio, Asst. Administrator.

SUPERVISOR'S NAME: David Sicairos	TELEPHONE: (323) 981-3982
LICENSING EVALUATOR NAME: Bennette Pena	TELEPHONE: (323) 981-3307
LICENSING EVALUATOR SIGNATURE:	DATE: 03/28/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/28/2024

LIC9099 (FAS) - (06/04)

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