198603286-9-13-2022-28-AS-RORN-CJGVJM-20220921162854

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198603286
Report Date: 09/13/2022
Date Signed: 09/13/2022 04:22:40 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
09/06/2022 and conducted by Evaluator Alma Gonzalez

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20220906150311

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: 58	DATE:	09/13/2022
		UNANNOUNCED	TIME BEGAN:	10:30 AM
MET WITH:	Alexander Solorio		TIME COMPLETED:	04:15 PM

ALLEGATION(S):

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Staff did not safeguard resident's funds

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Alma Gonzalez conducted an unannounced complaint visit to gather information pertaining to the above-mentioned allegation. LPA met with Assistant Administrator Alexander Solorio and explained the reason for the visit.

The investigation consisted of: LPA conducted interviews with Assistant Administrator Alexander Solorio, Staff 1-3 (S1-3), Residents 1-6 (R1-6). LPA obtained copies of Staff and Resident Rosters. LPA reviewed a sample number of a total of five (5) resident's Record of Client's/ Resident's Safeguarded Cash Resources and collected copies of LIC405 for each one.

(See LIC9099C for continuation)

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Stefanie Coronel	TELEPHONE: (323) 981-3961
LICENSING EVALUATOR NAME: Alma Gonzalez	TELEPHONE: (323) 981-3973
LICENSING EVALUATOR SIGNATURE:	DATE: 09/13/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/13/2022

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-20220906150311

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: 09/13/2022

NARRATIVE

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Investigation revealed the following: Regarding allegation, Staff did not safeguard resident's funds, it is alleged that R6 put money away and kept it by their bedside on 8/18/22 and on 8/23/22 the money was missing from the place that they last remember the money was placed. R6 is suspicious that the money might have been taken by a facility caregiver and declined to state the name. Interviews conducted with Assistant Administrator and S1-3 revealed that there have been no reports from any facility resident reporting missing money from their rooms and denied seeing any suspicious behavior from either residents or staff. Staff denied seeing resident go into R6's room or hang around anywhere near the hallway next to R6's room. Assistant
Assistant Administrator Solorio stated that R6 is a very vocal resident and they have not reported to him that they were missing any money from their room. Assistant Administrator stated that R6 rarely comes out of their room, does not have a roommate, is very alert and reports any concerns they have to him. Assistant Administrator and S1-3 deny that any facility staff have ever taken any money or anything else from any facility resident and stated that staff go in there when the resident needs assistance, when they need to clean, deliver food and collect clothes/ bed linens for laundry service. Interviews conducted with 5 out of 6 residents revealed that they do not have any concerns regarding their belongings and have not had anything taken from their rooms. 5 out of 6 residents stated that staff go into their rooms to clean and assist them when they need help and stated that they feel safe living at the facility. Interview with R6 revealed that they believe that the money was taken by another facility resident and not by a facility staff. R6 stated that they do not know which resident but have heard someone around their door but when they call out no one answers. LPA review of R6's Record of Client's/ Resident's Safeguarded Cash Resources (LIC405) did not reveal any discrepancies and LPA observed that the balance is accurate and observed the dates and signatures from staff and resident when money is withdrawn. LPA review of 4 additional LIC405's did not reveal any discrepancies.

Based on statements gathered from interviews conducted with staff, facility residents and LPA record review, there was not enough supportive evidence to concur with the reported allegation.

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.

Exit interview held. A copy of the report was provided to Assistant Administrator Alexander Solorio.

SUPERVISOR'S NAME: Stefanie Coronel	TELEPHONE: (323) 981-3961
LICENSING EVALUATOR NAME: Alma Gonzalez	TELEPHONE: (323) 981-3973
LICENSING EVALUATOR SIGNATURE:	DATE: 09/13/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/13/2022

LIC9099 (FAS) - (06/04)

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