198603286-3-21-2023-28-AS-RORN-CQSPZ8-20230411114507

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198603286
Report Date: 03/21/2023
Date Signed: 03/21/2023 12:08:35 PM

Unfounded

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
03/13/2023 and conducted by Evaluator Alberto Lopez

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20230313152725

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:	03/21/2023
		UNANNOUNCED	TIME BEGAN:	09:59 AM
MET WITH:	Alex Solorio, Assiistant Administrator.		TIME COMPLETED:	12:09 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Staff had inappropriate interactions with resident in care

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
11
12
13

Licensing Program Analyst (LPA) Alberto Lopez conducted an initial complaint visit for the above stated allegation. LPA met with Assistant Administrator Alex Solorio and explained the reason for the visit.

The investigation consisted of: LPA conducted an interview with Assistant Administrator Alex Solorio S1 and 4 additional staff S2-S5 LPA also interviewed Residents 1-7 (R1-R7) LPA also obtained copies of Staff and Client Rosters, sign in sheets for 02/2023 and 03/2023. LPA attempted to interview Visitor (V1). LPA also collect copiy of incident report 03/11/2023 and R1 physician’s report.

(Continued on 9099C)

Unfounded

Estimated Days of Completion:

SUPERVISOR'S NAME: Lisa Hicks	TELEPHONE: (323) 981-3972
LICENSING EVALUATOR NAME: Alberto Lopez	TELEPHONE: 323-980-4926
LICENSING EVALUATOR SIGNATURE:	DATE: 03/21/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/21/2023

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 2

Control Number 28-AS-20230313152725

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: 03/21/2023

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

(Continued from 9099)

Regarding Allegation: Staff had inappropriate interactions with resident in care. It is alleged that R1 had inappropriate relations with a visitor (V1). Administrator S1 stated that the alleged staff is not a staff at facility and not a volunteer but is rather a visitor of resident (R1). Assistant Administrator (S1) stated that V1 was introduced as R1’s girlfriend. R1 refused to discuss this allegation with LPA. Seven (7) out of 7 residents did not corroborate the allegation and some expressed shock that LPA would ask such a question. Several residents stated that all staff are very nice and do not know of any residents having inappropriate interactions with staff. LPA interviewed five (5) staff, and all stated they are unaware of any inappropriate interactions between staff and residents. Several staff stated they knew V1 to be girlfriend of R1 and that is how R1 introduced V1. LPA attempted to interview W1 and was unsuccessful. The investigation revealed that V1 is not an employee or volunteer at this facility.

This agency has investigated the complaint alleging, Staff had inappropriate interactions with resident in care. We have found that the complaint was UNFOUNDED, meaning that the allegation is false, could not have happened and/or are without reasonable basis. We have therefore dismissed the complaint.

Exit interview conducted with Assistant Administrator Alex Solorio. A copy of the report and appeal rights was provided.

SUPERVISOR'S NAME: Lisa Hicks	TELEPHONE: (323) 981-3972
LICENSING EVALUATOR NAME: Alberto Lopez	TELEPHONE: 323-980-4926
LICENSING EVALUATOR SIGNATURE:	DATE: 03/21/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/21/2023

LIC9099 (FAS) - (06/04)

Page: 2 of 2