198603286-2-16-2023-28-AS-FFIS-CPC46R-20230223174956

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198603286
Report Date: 02/16/2023
Date Signed: 02/16/2023 04:20:34 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
07/14/2020 and conducted by Evaluator Valeria Maldonado

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20200714152111

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: 68	DATE:	02/16/2023
		UNANNOUNCED	TIME BEGAN:	10:00 AM
MET WITH:	Alexander Solorio- Assistant Administrator		TIME COMPLETED:	04:30 PM

ALLEGATION(S):

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Facility is not able to meet the needs of residents due to inadequate staffing.
Staff failed to meet resident’s toileting needs in a timely manner.
Facility staff are not competent on how to use a hoyer lift.
Facility is unsanitary.
Facility staff failed to keep the facility in a comfortable temperature for residents.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) V. Maldonado made an subsequent unannounced visit at the facility for the purpose of invstigating the above-mentioned allegations. LPA Maldonado met with Assistant Administrator Alexander Solorio and explained the purpose for the visit.

On 07/23/20, LPA. Joe Katrdzhyan made an initial visit that was conducted telephonically with Exective Director Kandice Vergara, due to the situation surrounding the Coronavirus Disease 2019 (COVID-19), and to implement mitigation measures. During that visit, LPA Katrdzhyan requested the following documents for Resident# 1 (R1): Pre-placement Appraisal Information, Functional Capability Assessment, Physician's Report, Appraisal/Needs and Services Plan, Physician's order for a hoyer lift, Staff training conducted on the use of a hoyer lift, Resident Roster and Staff Roster.

(Report Continued on LIC9099-C...)

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Fernando Fierros	TELEPHONE: (323) 981-3981
LICENSING EVALUATOR NAME: Valeria Maldonado	TELEPHONE: 323-981-3342
LICENSING EVALUATOR SIGNATURE:	DATE: 02/16/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/16/2023

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-20200714152111

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: 02/16/2023

NARRATIVE

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During today's visit, LPA conducted a tour of the physical plant with Alexander and obtained a copy of the resident/staff roster, staff training conducted on the use of a hoyer lift and the following documents for Residents# 1-8, (R1-R8): Facesheet, Physician's Report, Needs and Services Plan. LPA also requested the following for R1: Physician's order for a hoyer lift and incident reports for R1 for the months of July-August 2020, and interviewed Staff# 1-4 (S1-S4) and R2-R8.

The investigation revealed the following:

Regarding allegation: Facility is not able to meet the needs of residents due to inadequate staffing.
It is alleged that the facility is short staffed to operate safely, with only 2 caregivers for 42 residents. Per interviews conducted, (4) of (4) staff state there are 2 caregivers per shift, with the majority of the residents being independent and requiring minimal assistance with their Activities of Daily Living (ADL). (6) of (8) residents stated that all of their needs are being met. After review of the documents obtained for R1-R8, none of the residents require a 1:1 assistance/supervision. This allegation is unsubstantiated.
Regarding allegation: Staff failed to meet resident’s toileting needs in a timely manner.
It is alleged that R1 waited for 3 hours to be removed from the commode (toilet) after taking staff 2.5 hours to be taken to the commode. (4) of (4) state that residents are assisted within 5-10 minutes of their requests, and residents who require toileting assistance are regularly checked on every 2 hours. (1) of (8) residents state that they require assistance with toileting and are assisted timely. This allegation is unsubstantiated.
Regarding allegation: Facility staff are not competent on how to use a hoyer lift.
It is alleged that there is a hoyer lift in the facility, but staff do not know how to use it. (4) of (4) staff state that training was provided via videos and in-person by the assistant administrator and is currently being used for 2 residents. (6) of (8) residents state they do not require transfer with a hoyer and staff assist them by lifting them between 2 caregivers. All residents denied being hurt by transfer or being concerned with the staff training on assistance with transferring them. This allegation is unsubstantiated.
Regarding allegation: Facility is unsanitary.
It is alleged that a resident observed urine on the floor and the facility smelled like feces. LPA conducted a tour of the physical plant and common areas and observed housekeeping cleaning the hallways and rooms. LPA did not smell or observe urine or feces. (4) of (4) staff state the facility is cleaned daily and as needed. (6) of (8) residents denied the allegation and stated the facility is kept clean and sanitary. This allegation is denied.
(Report Continued on LIC9099-C...)

SUPERVISOR'S NAME: Fernando Fierros	TELEPHONE: (323) 981-3981
LICENSING EVALUATOR NAME: Valeria Maldonado	TELEPHONE: 323-981-3342
LICENSING EVALUATOR SIGNATURE:	DATE: 02/16/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/16/2023

LIC9099 (FAS) - (06/04)

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Control Number 28-AS-20200714152111

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: 02/16/2023

NARRATIVE

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Regarding allegation: Facility staff failed to keep the facility in a comfortable temperature for residents.
It is alleged that one side of the building is 20 degrees cooler than the other side and the AC is kept running all night making it really cold. LPA observed the electrical room where the thermostats are located and observed 11 thermostats, all set to 76*F. (4) of (4) staff state that if residents have concerns about the temperature, the staff will adjust it to accommodate the residents. (6) of (8) residents denied the allegation and stated that if they have concerns about the temperature, staff will adjust it to accommodate them. This allegation is unsubstantiated.

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: Fernando Fierros	TELEPHONE: (323) 981-3981
LICENSING EVALUATOR NAME: Valeria Maldonado	TELEPHONE: 323-981-3342
LICENSING EVALUATOR SIGNATURE:	DATE: 02/16/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/16/2023

LIC9099 (FAS) - (06/04)

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