198603286-6-23-2021-28-AS-CYEE-C6CSMD-20210829135945

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198603286
Report Date: 06/23/2021
Date Signed: 06/23/2021 12:04:43 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
06/16/2021 and conducted by Evaluator Linda M Almaraz

COMPLAINT CONTROL NUMBER: 28-AS-20210616113957

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: 39	DATE:	06/23/2021
		UNANNOUNCED	TIME BEGAN:	10:16 AM
MET WITH:	Assistant Administrator, Alexander Solorio		TIME COMPLETED:	12:15 PM

ALLEGATION(S):

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Staff did not ensure a comfortable temperature is present in the facility

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Linda Almaraz conducted a complaint visit to investigate the allegation listed above. LPA met with Assistant Administrator, Alexander Solorio and discussed the reason for todays visit.

The investigation consisted of the following: LPA conducted interviews with Solorio, Staff #1-2, Residents #1-9 and attempted to interview Resident #10 but was asleep, Resident #11 was out in the community and Resident #13 moved out of the facility. LPA did a walk-through of the facility, interviewed residents in their rooms, inspected rooms of residents not present at the facility, and verified thermostat readings. LPA requested copies of Staff and Resident rosters, and records for Resident #1 and #13.

The investigation revealed the following: It was alleged the facility temparature was too hot, at a temperature of 103 degrees F. During the facility walk-through with Solorio, LPA witnessed and felt the Air Conditioning working and the facility temperature was fresh and verified within 76-78 degrees F. (Continued on LIC 9099C)

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Christine Yee	TELEPHONE: (323) 981-3978
LICENSING EVALUATOR NAME: Linda M Almaraz	TELEPHONE: (323) 981-3307
LICENSING EVALUATOR SIGNATURE:	DATE: 06/23/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/23/2021

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-20210616113957

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: 06/23/2021

NARRATIVE

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Based on interviews conducted with Solorio and staff, the facility is always at a cool comfortable temperature. Staff indicate that residents sometimes are too cold and they need to adjust the thermostat to accommodate them. Per Staff interviews, the Air Conditioning is set at a certain temperature and turns off once the set temperature is reached. Resident interviews revealed the facility never gets too hot and the Air Conditioning is always working. Eight (8) out nine (9) residents interviewed indicated they are comfortable with the temperature. Some residents indicated they are cold at night but do not ask the staff to adjust the temperature to accommodate their roommate.

Based on LPA's observations and interviews, investigation revealed: 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 allegation is unsubstantiated.

No Deficiencies cited under California Code of Regulations Title 22. Exit interview conducted, and a copy of report was provided to Assistant Administrator.

SUPERVISOR'S NAME: Christine Yee	TELEPHONE: (323) 981-3978
LICENSING EVALUATOR NAME: Linda M Almaraz	TELEPHONE: (323) 981-3307
LICENSING EVALUATOR SIGNATURE:	DATE: 06/23/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/23/2021

LIC9099 (FAS) - (06/04)

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