198603286-7-14-2023-28-AS-RORN-CTWS69-20230720133534

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198603286
Report Date: 07/14/2023
Date Signed: 07/14/2023 12:56:45 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
06/02/2021 and conducted by Evaluator Erik Zaragoza

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20210602161100

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: 73	DATE:	07/14/2023
		UNANNOUNCED	TIME BEGAN:	09:27 AM
MET WITH:	Alexander Solorio - Assistant Administrator		TIME COMPLETED:	01:10 PM

ALLEGATION(S):

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Facility staff is providing medical care to residents in care

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Erik Zaragoza conducted a follow up complaint investigation regarding the allegation listed above. LPA met with Alexander Solorio Assistant Administrator reason for the visit.

The investigation revealed the following: during the initial visit conducted on 06/11/2021, LPAs Nicol Wesley and Nune Margaryan interviewed the Executive Director and Assistant Administrator, requested to review a random selection of residents files, requested a copy of the staff roster and resident roster. During today's visit, LPA Zaragoza interviewed Residents 1 - 9 (R1, R2, R3, R4, R5, R6, R7, R8, R9), Staff # 1 - 5 (S1, S2, S3, S4, S5). LPA also obtained copies of the following documentation: Staff Roster, Client Rosters, Physicians Reports for R1 - R9, and Medication Administration Records (MARs) for R1 - R9.

The investigation revealed the following: in regards to the allegation "Facility staff is providing medical care to residents in care", it is alleged that S1 is providing in-house medical care to the residents as well as signing their physician's reports and prescribing medications while his license is on probation.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: David Sicairos	TELEPHONE: (323) 981-3982
LICENSING EVALUATOR NAME: Erik Zaragoza	TELEPHONE: (323) 981-3983
LICENSING EVALUATOR SIGNATURE:	DATE: 07/14/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/14/2023

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-20210602161100

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: 07/14/2023

NARRATIVE

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During an interview with S1 over the phone, S1 stated they have provided medical care to the residents of the facility in the past and occasionally does come in to do so, however this should not be an issue. S1 explained that he is a board certified physician and has several years experience treating the elderly in assisted living facilities and skilled nursing facilities. S1 explained they also work with Department of Health Services (DHS) patients and that DHS has asked him previously for assistance in providing care to residents in the facility, and that other residents are former patients of S1's. During interviews with the residents, R1 - R9 explained that they have never heard of S1 before, nor have they ever received direct in-house medical care from S1. R1 - R9 also explained that they have the choices on whether they want to see the in-house doctors the facility provides or another medical provider, and they all stated that they do not pay for their medical services. R1, R8, and R9 also stated that they have their own medical team that they work with outside of the facility. Interviews with S2 revealed that S1 has not signed a physician's report for the residents in the past year, and that the facility is working with another medical provider who is signing the residents physician's reports and updating their medications if the residents choose to accept medical care from their in-house medical team, and that residents always have a choice in who they see as their primary medical provider. Interviews with S3 - S5 revealed that none have seen S1 providing direct medical care directly to the patients, and that residents are never forced to see S1 or their in-house physician. A review of the R1 - R9's medical assessments and MARs did not show S1 to have signed any assessments, they were all signed either from the facility's in-house medical provider or their own chosen physician from outside the facility.

Based on statements and interviews conducted with staff, clients, review of client files and facility file records, there was not enough supportive evidence to concur with the reported allegations. 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 this report was provided.

SUPERVISOR'S NAME: David Sicairos	TELEPHONE: (323) 981-3982
LICENSING EVALUATOR NAME: Erik Zaragoza	TELEPHONE: (323) 981-3983
LICENSING EVALUATOR SIGNATURE:	DATE: 07/14/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/14/2023

LIC9099 (FAS) - (06/04)

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