198603286-5-11-2023-28-AS-MVAO-CRVQJJ-20230516121248

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198603286
Report Date: 05/11/2023
Date Signed: 05/11/2023 05:32:39 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
05/01/2023 and conducted by Evaluator Angelica Rea

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20230501100330

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: 76	DATE:	05/11/2023
		UNANNOUNCED	TIME BEGAN:	04:45 PM
MET WITH:	Alex Solorio		TIME COMPLETED:	05:30 PM

ALLEGATION(S):

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Staff financially abused resident in care.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Angelica Rea conducted another visit to issue the final results of the investigation. LPA met with Administrator, Alex Solorio who assisted with today's visit.

Regarding the allegation that staff financially abused resident in care, the investigation consisted of : review of resident #1's file, interviews with Administrator, Staff #1 and resident #1 - resident #7. Administrator and Staff #1 denied the allegation. Staff interviewed stated that on 4/18/23, resident #1 began stating that the facility owed him money. Staff interviewed stated that they showed resident #1 his P & I log, which showed that resident #1 had taken out all of his funds. Resident #1 became very upset, when he was told this. Staff stated that it was decided that the facility would give resident #1 additional funds in order to avoid behavioral issues and to de-escalate the situation. Staff stated that they asked resident #1 to sign a document stating that he has received his P & I money, and is up to date. LPA observed a copy of the document signed by resident #1, dated 4/18/23. The facility submitted a special incident report to Community Care Licensing on 4/18/23 for this incident. Residents interviewed were unable to corroborate the allegation. Resident #2 -resident #7 stated that they do receive their P & I funds. They stated that they are not being financially abused by staff.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Lisa Hicks	TELEPHONE: (323) 981-3972
LICENSING EVALUATOR NAME: Angelica Rea	TELEPHONE: (323) 980-4929
LICENSING EVALUATOR SIGNATURE:	DATE: 05/11/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/11/2023

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-20230501100330

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: 05/11/2023

NARRATIVE

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Based on LPA's observations and interviews, investigation revealed: Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is unsubstantiated.

No Deficiencies cited under California Code of Regulations Title 22. Exit interview conducted, and a copy of report was provided to Resident Care Director, Maria "Luisa" Razo.

SUPERVISOR'S NAME: Lisa Hicks	TELEPHONE: (323) 981-3972
LICENSING EVALUATOR NAME: Angelica Rea	TELEPHONE: (323) 980-4929
LICENSING EVALUATOR SIGNATURE:	DATE: 05/11/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/11/2023

LIC9099 (FAS) - (06/04)

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