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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198603286
Report Date: 09/13/2022
Date Signed: 09/13/2022 04:13:47 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
09/09/2022 and conducted by Evaluator Alma Gonzalez
PUBLIC
COMPLAINT CONTROL NUMBER: 28-AS-20220909160319
FACILITY NAME:PASADENA VILLA SENIOR LIVINGFACILITY NUMBER:
198603286
ADMINISTRATOR:MURPHY, MICHAELFACILITY TYPE:
740
ADDRESS:1811 N. RAYMOND AVETELEPHONE:
(626) 791-6232
CITY:PASADENASTATE: CAZIP CODE:
91103
CAPACITY:97CENSUS: 58DATE:
09/13/2022
UNANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH:Alexander SolorioTIME COMPLETED:
04:15 PM
ALLEGATION(S):
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Facility has pests
Licensee does not maintain facility clean and sanitary at all times
Licensee does not provide resident with basic laundry service
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 allegations. 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 attempted to conduct an interview with R7 but they were out of the facility. LPA called R7 to attempt to conduct a telephone interview but did not receive a call back. LPA obtained copies of Staff and Resident Rosters, Pest Control Invoices for July - September 2022, laundry schedule, and shower schedule. LPA conducted a tour of the facility with Assistant Administrator which included observations of a random selection of resident rooms, facility bathrooms, Activity room and outside patio areas.

(See LIC9099C for continuation)
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Stefanie CoronelTELEPHONE: (323) 981-3961
LICENSING EVALUATOR NAME: Alma GonzalezTELEPHONE: (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)
Page: 1 of 3
Control Number 28-AS-20220909160319
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, Facility has pests, it is alleged that the facility has roaches. Interviews conducted with Assistant Administrator and S1-3 revealed that there are no roaches in the facility. Staff also stated that the facility is serviced monthly by a pest control company. Assistant Administrator stated that he has not been approached by any facility resident reporting that they have seen roaches and stated that the facility residents are very vocal and know when, where and to who they can report any concerns regarding anything at the facility. Interviews conducted with 4 out of 6 residents revealed that they have not seen any roaches at the facility. LPA toured the facility including resident rooms and did not observe any roaches or any other pest and or rodents during the tour. LPA observed the facility to be clean during the tour. Based on statements gathered from interviews conducted with staff, facility residents, LPA record review and observations, there was not enough supportive evidence to concur with the reported allegation.


For allegation, Licensee does not maintain facility clean and sanitary at all times, it is alleged that all three showers at the facility are always filthy, and are not cleaned regularly. Showers are supposed to be cleaned twice a day but is allegedly this is not happening. It is also alleged that housekeeping duties which include resident rooms being cleaned, floors swept and mopped on a schedule are not being performed due to the facility being short staffed. Interviews with 6 of 7 residents indicate facility staff are providing housekeeping services daily and full cleaning services on a weekly basis. 6 out of 7 residents stated that the showers are cleaned regularly and they see staff cleaning the showers more that twice a day. Interviews with housekeeping staff indicate they clean the facility including all three showers and Resident bedrooms on a daily basis. Staff also stated that resident rooms and showers are also cleaned as needed so it might be more than a couple of times a day depending on the need for service. Assistant Administrator and S1-3 stated that they believe that there are enough staff on schedule to care for all facility residents. 6 out of 7 residents stated that they are satisfied with the services and do not have any concerns regarding the facility not being cleaned on a daily basis. LPA observed the facility and all three showers to be clean during the tour. Based on statements gathered from interviews conducted with staff, facility residents, and LPA observations, there was not enough supportive evidence to concur with the reported allegation.
SUPERVISOR'S NAME: Stefanie CoronelTELEPHONE: (323) 981-3961
LICENSING EVALUATOR NAME: Alma GonzalezTELEPHONE: (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)
Page: 2 of 3
Control Number 28-AS-20220909160319
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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For allegation, Licensee does not provide resident with basic laundry service, it is alleged that facility staff did not follow laundry schedule and did not ensure that R7's laundry was done. Interviews with 6 of 7 residents indicate they do not have any concerns regarding the laundry schedule/ service and stated that their laundry is done weekly as scheduled and their bed linens and sheets are cleaned twice a week. 6 out of 7 residents stated that they are satisfied with the laundry and linen services and do not have any concerns. Assistant Administrator and S1-3 stated that residents laundry service is conducted on a weekly schedule and resident's bed linens are cleaned twice a week on the same day as the resident's shower schedule and as needed depending on if a resident has had an accident that requires an immediate change of soiled linens and also stated that the same applies for laundry service. Based on statements gathered from interviews conducted with staff, facility residents, LPA record review and observations, there was not enough supportive evidence to concur with the reported allegation.

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. A copy of the report was provided to Assistant Administrator Alexander Solorio.
SUPERVISOR'S NAME: Stefanie CoronelTELEPHONE: (323) 981-3961
LICENSING EVALUATOR NAME: Alma GonzalezTELEPHONE: (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)
Page: 3 of 3