198603286-3-28-2023-28-AS-RORN-CQEN7F-20230330101240

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198603286
Report Date: 03/28/2023
Date Signed: 03/28/2023 02:02:51 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
03/20/2023 and conducted by Evaluator Kruz Long

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20230320081049

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: 70	DATE:	03/28/2023
		UNANNOUNCED	TIME BEGAN:	09:45 AM
MET WITH:	Alexander Solorio (Assistant Administrator)		TIME COMPLETED:	02:15 PM

ALLEGATION(S):

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Staff are not cleaning resident's room.
Staff are not doing resident's laundry timely.
Staff do not provide resident with enough linens.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Kruz Long conducted an unannounced complaint investigation at the facility. Upon arrival, LPA met with Alexander Solorio (Assistant Administrator) and explained the purpose of the visit.

During today's visit, LPA obtained/reviewed a copy of the Staff/Resident rosters, laundry schedule, bedding schedule, Linen invoice and housekeeping schedule, toured various Resident bedrooms and linen storage, interviewed Staff #1 to #5 in the office and interviewed Residents #1 to # 7 in the office.

In regards to the allegation: Staff are not cleaning resident's room. Interviews with 5 of 5 Staff indicate Resident's rooms are clean on a regular basis and on an as needed basis. Interviews with 7 of 7 Resident indicate that their rooms are clean on a regular basis and also on an as needed basis. Review of the Housekeeping schedule indicate Resident's rooms are cleaned on a regular basis. LPA toured various Resident bedrooms and observed the bedrooms to be clean. Continue to LIC9099C......

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Fernando Fierros	TELEPHONE: (323) 981- 3981
LICENSING EVALUATOR NAME: Kruz Long	TELEPHONE: (323) 383-8117
LICENSING EVALUATOR SIGNATURE:	DATE: 03/28/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/28/2023

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-20230320081049

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: 03/28/2023

NARRATIVE

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In regards to the allegation: Staff are not doing resident's laundry timely. Interviews with 7 of 7 Residents indicate that laundry is done at least once a week and on an as needed basis. Residents also stated that laundry is done timely. Interviews with Staff also indicate laundry services is done timely at least once a week and on an as needed basis. Review of the laundry schedule indicate Staff is scheduled to perform laundry services everyday.

In regards to the allegation: Staff do not provide resident with enough linens. LPA toured the linen storage areas and observed the facility to have sufficient linen supplies such as bedsheets, blankets and towels. Interviews with 7 of 7 Residents indicate that they are provided enough linens. Interviews with 5 of 5 Staff also indicate Residents are provided with enough linens.

Based on LPA's record review, observations and interviews, the investigation revealed: Although the allegations may have happened or is 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 conducted with Alexander Solorio and a copy of this report provided.

SUPERVISOR'S NAME: Fernando Fierros	TELEPHONE: (323) 981- 3981
LICENSING EVALUATOR NAME: Kruz Long	TELEPHONE: (323) 383-8117
LICENSING EVALUATOR SIGNATURE:	DATE: 03/28/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/28/2023

LIC9099 (FAS) - (06/04)

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