198603286-8-12-2025-28-AS-WSHO-DL8Q8Y-20250905115731

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198603286
Report Date: 08/12/2025
Date Signed: 08/12/2025 12:30:42 PM

Unsubstantiated

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
08/05/2025 and conducted by Evaluator Glenn Trueman

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20250805122051

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: 59	DATE:	08/12/2025
		UNANNOUNCED	TIME BEGAN:	09:30 AM
MET WITH:	Bryanna Luke, Administrator		TIME COMPLETED:	12:45 PM

ALLEGATION(S):

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Staff do not ensure residents medical needs are met

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Glenn Trueman conducted an unannounced initial complaint visit to investigate the above allegation. LPA met with Bryanna Luke, Administrator and explained the purpose of the visit.

The investigation consisted of the following: LPA obtained and reviewed the staff & resident rosters, and Resident (R1's) file such as: Face Sheet, Admission Agreement, and Physician's Report. LPA interviewed the Administrator, Staff (S1) and Resident (R1) - Resident (R5).
Interview was conducted telephonically with Wound Care Specialist.

The investigation revealed the following: In regards to the allegation Staff do not ensure residents medical needs are met, based on interviews conducted and information gathered it was revealed by the Wound Care Specialist that visits are done every Monday and Wednesday at the facility and Resident R1 is being treated for wounds on the leg and face.

Unsubstantiated

Estimated Days of Completion:

NAME OF LICENSING PROGRAM MANAGER: Wei Siew Ho
NAME OF LICENSING PROGRAM ANALYST: Glenn Trueman
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 08/12/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/12/2025

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-20250805122051

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: 08/12/2025

NARRATIVE

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Stated several times Resident R1 refused to leave the facility to see a specialist as was advised. Resident R1 just wants cream on it.
Said Resident R1 is self responsible and has gone to the hospital before and they don't keep him.
Stated Resident R1 manages own care and can't force to leave the facility.
Said the staff are doing a good job providing care for Resident R1.
Spoke with Resident R1 who stated that he will refuse care. Said he doesn't want to lose Pasadena Villa as his home.
Stated previously staff said it would be quick and he was in the hospital for months.
Said he needs a place to pray and other facility's won't allow it.
Stated he doesn't want staff to give medical attention because he doesn't want to leave here, but they will try to help and assist medically.
Staff stated that the Wound Care Specialist comes to the facility on Monday and Wednesday.
Stated they do try to assist with medical attention, but Resident R1 refuses with the facility and the Wound Care Specialist.
Said 911 is for emergency and Resident R1 is self responsible and does not want to leave to see a specialist.
Wound Care Notes were documented and reviewed and specified 2 days a week visits for Resident R1.
Spoke with Resident's R1- R5 who all stated that staff will provide medical attention when they need it.
Stated staff assist right away if they need 911 or to go to the hospital.

Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegations are UNSUBSTANTIATED.

An exit interview was held,

NAME OF LICENSING PROGRAM MANAGER: Wei Siew Ho
NAME OF LICENSING PROGRAM ANALYST: Glenn Trueman
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 08/12/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/12/2025

LIC9099 (FAS) - (06/04)

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