198603286-2-16-2022-28-AS-MVAO-CDFUQB-20220413154652

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198603286
Report Date: 02/16/2022
Date Signed: 02/16/2022 01:40:26 PM

Substantiated

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
02/14/2022 and conducted by Evaluator Christine Wong

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20220214123417

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: 54	DATE:	02/16/2022
		UNANNOUNCED	TIME BEGAN:	09:00 AM
MET WITH:	Alexander Solorio		TIME COMPLETED:	02:30 PM

ALLEGATION(S):

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Facility does not meet the American Disabilities Act Standards for wheelchairs

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Christine Wong conducted an initial 10 days complaint visit to investigate the above allegation. LPA met with Assistant Administrator- Alexander Solorio and explained the reason of the visit and he also assisted LPA with the visit.

The investigation consisted of the following: On today's visit, LPA interviewed the four (4) staff, seven (7) residents and toured the front door and two fire doors in the back which lead to the patio. LPA also obtained the copy of resident and staff roster.

The investigation revealed of the following:

Allegtation " Facility does not meet the American Disabilities Act Standards for wheelchairs."
(See LIC 9099C for continuation)

Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Christine Yee	TELEPHONE: (323) 981-3978
LICENSING EVALUATOR NAME: Christine Wong	TELEPHONE: (323) 981-3963
LICENSING EVALUATOR SIGNATURE:	DATE: 02/16/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/16/2022

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

Page: 1 of 3

Control Number 28-AS-20220214123417

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: 02/16/2022

NARRATIVE

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LPA observed all the doors in the facility does meet the Americans Disabilities Act Standard for wheelchairs. However, LPA interviewed seven (7) residents and four (4) residents reported sometimes their wheelchair did get stuck when they went through the door due to one side of the door was not wide enough for them to go through. The residents reported especially the two fire doors in the back which lead to the patio, the doors are very heavy and sometimes its difficult for the residents to push it while they are on the wheelchair. LPA also interviewed staff and reported they did receive suggestions and complaints from residents about the two fire doors in the back which is not an easy access for the residents to go through especially on the wheelchair. Residents sometimes required assistance from staff to open the door for them. LPA also observed the two fire doors in the back and required to open the left side of the door first then the right side and the doors are heavy to push it.

Based on the statements and interviews from residents and staff and LPA's observation, the preponderance of evidence standard has been met, therefore, the above allegation is found to be SUBSTANTIATED. California Code of Regulations, Title 22, Division 6 and Chapter 8, are being cited on the attached LIC 9099D.

An exit interviewed was conducted. The Plan of Corrections were reviewed and developed with the Assistant Administrator- Alexander Solario. A copy of this report, LIC9099D, and appeal rights were provided.

SUPERVISOR'S NAME: Christine Yee	TELEPHONE: (323) 981-3978
LICENSING EVALUATOR NAME: Christine Wong	TELEPHONE: (323) 981-3963
LICENSING EVALUATOR SIGNATURE:	DATE: 02/16/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/16/2022

LIC9099 (FAS) - (06/04)

Page: 2 of 3

Control Number 28-AS-20220214123417

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
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 02/16/2022

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 03/02/2022 Section Cited CCR 87468.2(a)(14)	1 2 3 4 5 6 7	87468.2 Additional Personal Rights of Residents in Privately Operated Facilities (a) In addition to the rights listed in Section 87468.1...following personal right (14)To reasonable accommodation of their individual needs and preferences in all aspects of life in the facility.	1 2 3 4 5 6 7	The Executive Director will come up a plan for how to make the doors to be easy access for the residents who use the wheelchair to go through. The Executive will send the plan to LPA by POC due date.
	8 9 10 11 12 13 14	The requirement is not met as evidenced by LPA's observation and interviews by residents and reported the doors are not easy access for the residents use wheelchairs to go through which pose an potential risk for residents in care.	8 9 10 11 12 13 14
	1 2 3 4 5 6 7		1 2 3 4 5 6 7
	1 2 3 4 5 6 7		1 2 3 4 5 6 7

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

SUPERVISOR'S NAME: Christine Yee	TELEPHONE: (323) 981-3978
LICENSING EVALUATOR NAME: Christine Wong	TELEPHONE: (323) 981-3963
LICENSING EVALUATOR SIGNATURE:	DATE: 02/16/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/16/2022

LIC9099 (FAS) - (06/04)

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