198603286-10-20-2022-28-AS-RORN-CL2LJR-20221110074819

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198603286
Report Date: 10/20/2022
Date Signed: 10/20/2022 03:35:28 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
GREATER LA AC/SC, 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
07/09/2020 and conducted by Evaluator Luis Mora

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20200709092002

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: 57	DATE:	10/20/2022
		UNANNOUNCED	TIME BEGAN:	09:00 AM
MET WITH:	Alexander Solorio - Assistant Administrator		TIME COMPLETED:	03:50 PM

ALLEGATION(S):

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Facility does not have hot water for bathing and hygiene.
Facility does not serve food of the quality necessary to meet the needs of the residents.
Meals are not being planned with consideration of resident's religious practices.
Meals are served cold.

INVESTIGATION FINDINGS:

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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: On 07/16/2020, LPA Katrdzhyan conducted telephone interviews with the Executive Director and Resident Care Director. On today's visit, LPA Mora obtained a copy of the resident and staff rosters, menu, alternate menu, conducted a tour of the facility, and interviewed the Assistant Administrator, Staff 1 – Staff 2 (S1–S2), and Resident 1 – Resident 7 (R1-R7).

The investigation revealed the following: regarding the allegation "facility does not have hot water for bathing and hygiene" it is alleged that residents have reported to the facility that they do not have hot water in their rooms and showers, but nothing has been done. (CONTINUED TO LIC 9099C)

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Wei Siew Ho	TELEPHONE: (323) 981-3969
LICENSING EVALUATOR NAME: Luis Mora	TELEPHONE: 323-981-3964
LICENSING EVALUATOR SIGNATURE:	DATE: 10/20/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/20/2022

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-20200709092002

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
GREATER LA AC/SC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754

FACILITY NAME: PASADENA VILLA SENIOR LIVING	FACILITY NUMBER: 198603286
	VISIT DATE: 10/20/2022

NARRATIVE

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Assistant Administrator and staff interviewed could not corroborate with the allegation and stated that if they are made aware of any water temperature issues, it is quickly addressed by the maintenance staff. Residents interviewed could not corroborate with the allegation and stated that they do have warm water in their restrooms and the community bathrooms. LPA toured the facility and observed that bedrooms have a restroom and the facility have community bathrooms for residents to shower. LPA measured the water temperature in 7 resident restrooms and 1 community bathroom, and all measured within required water temperature which is between 105 degrees F and 120 degrees F.

Regarding the allegation "facility does not serve food of the quality necessary to meet the needs of the residents" it is alleged that the food is bland and catered to individuals that have special dietary restrictions due to health issues and that food does not have salt, butter, or flavor and is often unrecognizable. Assistant Administrator and staff interviewed could not corroborate with the allegation and stated that they follow the recipes of a nutritionist. They also stated that salt, pepper, and other condiments are provided on the side for the residents to adjust the flavor of the food to their liking. Residents interviewed could not corroborate with the allegation and stated that the food is good and confirmed that condiments are available if requested.

Regarding the allegation "meals are not being planned with consideration of resident's religious practices" it is alleged that the facility is aware of the residents religious practices, but still serve foods that the residents are not allowed to eat. Assistant Administrator and staff interviewed could not corroborate with the allegation and stated that they have a list of residents with dietary restrictions and they provide these residents with an alternate menu. Residents interviewed could not corroborate with the allegation and stated that the facility does provide an alternate menu.

Regarding the allegation "meals are served cold." it is alleged that food was being delivered to the residents bedroom late and cold. Assistant Administrator and staff interviewed could not corroborate with the allegation and stated that during Covid-19 they were serving and delivering 10 plates at a time to prevent delivering cold food. Residents interviewed could not corroborate with the allegation and stated that they receive their food in a reasonable hot temperature.

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: Wei Siew Ho	TELEPHONE: (323) 981-3969
LICENSING EVALUATOR NAME: Luis Mora	TELEPHONE: 323-981-3964
LICENSING EVALUATOR SIGNATURE:	DATE: 10/20/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/20/2022

LIC9099 (FAS) - (06/04)

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