198603286-8-4-2022-28-AS-MVAO-CHDV2N-20220817160325

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198603286
Report Date: 08/04/2022
Date Signed: 08/04/2022 03:17:30 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
04/12/2021 and conducted by Evaluator Luis Mora

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20210412151359

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:	08/04/2022
		UNANNOUNCED	TIME BEGAN:	08:30 AM
MET WITH:	Alexander Solorio - Assistant Administrator		TIME COMPLETED:	12:00 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Facility is retaliating against resident for making complaints.
Facility not meeting the needs of resident.

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
11
12
13

Licensing Program Analyst (LPA) Luis Mora conducted an unannounced complaint visit to determine the validity of the above-mentioned allegations. LPA met with Assistant Administrator Alexander Solorio and explained the reason for the visit.

The investigation consisted of the following: LPA obtained a copy of the residents and staff rosters, conducted a tour, and interviewed the Administrator, Staff 1 – Staff 2 (S1–S2), and Resident 1 – Resident 7 (R1-R7).

The investigation revealed the following: regarding the allegations "facility is retaliating against resident for making complaints" and "facility not meeting the needs of resident", it is alleged that a staff retaliated against this resident by turning off the air conditioner or increasing the heat of the air conditioner in this resident's room. The resident requested for the air conditioner to be turned on at a cold temperature.
(CONTINUED TO LIC 9099C)

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Stefanie Coronel	TELEPHONE: (323) 981-3961
LICENSING EVALUATOR NAME: Luis Mora	TELEPHONE: 323-981-3964
LICENSING EVALUATOR SIGNATURE:	DATE: 08/04/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/04/2022

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 2

Control Number 28-AS-20210412151359

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: 08/04/2022

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

Interviews with the assistant administrator and staff revealed that this resident wanted the temperature to be set at 66 degrees or lower. The facility has a total of 11 thermostats and there are a total of 11 air conditioner units. Each air conditioner unit is shared among 6-8 rooms. The other residents that shared the air conditioner with the resident in question complained that it was too cold. The facility adjusted the temperature per Title 22 which states "the facility shall cool rooms to a comfortable range, between 78 degrees F (26 degrees C) and 85 degrees F (30 degrees C), or in areas of extreme heat to 30 degrees F less than the outside temperature." The resident in question was given a fan to maintain cool, but did not like it. The facility also offered to move the resident to another room with less occupied rooms around that room because this will allow them to set the thermostat in that area to the resident's desired temperature, but the resident refused to move. The resident also accused the facility of turning off the air conditioner, but staff explained that the thermostats are set a specific temperature and once the room reaches the temperature then the air conditioner turns off automatically. The air conditioner will turn back on once the temperature starts to increase. Interviews conducted with residents revealed that they don't have a problem with the temperature and confirm that their rooms are at a comfortable temperature at all times. They also stated that if it gets too cold or hot then facility takes action immediately. LPA toured the facility and 7 random rooms, and confirmed a comfortable temperature in all areas. LPA also observed the 11 thermostats and confirmed that the temperature is set at 78 degrees.

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 held and a copy of the report was provided.

SUPERVISOR'S NAME: Stefanie Coronel	TELEPHONE: (323) 981-3961
LICENSING EVALUATOR NAME: Luis Mora	TELEPHONE: 323-981-3964
LICENSING EVALUATOR SIGNATURE:	DATE: 08/04/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/04/2022

LIC9099 (FAS) - (06/04)

Page: 2 of 2