198603286-8-31-2023-28-AS-TVAO-CVLLV5-20230912090455

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198603286
Report Date: 08/31/2023
Date Signed: 08/31/2023 03:25:57 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
07/17/2023 and conducted by Evaluator Cynthia D Chan

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20230717153428

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: 75	DATE:	08/31/2023
		UNANNOUNCED	TIME BEGAN:	10:30 AM
MET WITH:	Alex Solorio, Assistant Administrator		TIME COMPLETED:	03:30 PM

ALLEGATION(S):

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Staff did not provide medical attention to resident.
Staff refused to provide resident breakfast.
Staff did not provide resident with a towel to shower.
Staff does not treat resident with respect and dignity.
Staff took resident’s debit card.

INVESTIGATION FINDINGS:

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8 Licensing Program Analyst (LPA) Cynthia Chan conducted a subsequent complaint investigation for the allegations listed above. LPA met with Assistant Administrator, Alex Solorio, and explained the reason for the visit.

On 7/21/23, LPA conducted the initial visit and obtained copies of the staff roster, resident roster, and documents pertaining to Resident #1 (R-1). LPA also interviewed the Assistant Administrator and 4 Staff today. During the visit today, LPA interviewed 9 Residents.

The investigation revealed the following:
Allegation - Staff did not provide medical attention to resident. It was alleged that Resident #1 (R-1) had bruises and scratch marks that R-1 felt needed to be treated, however, staff did not provide an answer.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Tony Vasallo	TELEPHONE: (323) 981-3977
LICENSING EVALUATOR NAME: Cynthia D Chan	TELEPHONE: (323) 981-3370
LICENSING EVALUATOR SIGNATURE:	DATE: 08/31/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/31/2023

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-20230717153428

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: 08/31/2023

NARRATIVE

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LPA interviewed 5 Staff, and all denied not providing medical attention to anyone who needs it. They stated that in R-1’s situation, they would notice R-1 returning to the facility with scratch marks and bruises. Per staff, they are sometimes able to provide first aide to clean the marks and often times, R-1 refuses any medical attention or assistance from staff. LPA interviewed 9 Residents and all reported that staff provide medical attention when necessary.

Allegation - Staff refused to provide resident breakfast. Per staff interviewed, residents are served 3 meals a day plus snacks. Breakfast is normally served between 8 – 9am. If a resident requests a plate after the breakfast hours, they would offer an alternative since the kitchen staff are preparing for lunch. Staff will try their best to accommodate residents when they request for food and would never allow them to be hungry. Interviews with residents revealed that they are served 3 meals a day and provided with snacks. Some stated they eat before going out in the mornings. Some also stated they choose to eat out because they do not like the selection and not because they are not denied food.

Allegation - Staff did not provide resident with a towel to shower. Per Staff, the residents are provided with 2 towels and washcloths a week for showers and are replaced weekly. If a resident requests for more towels, the staff will provide to them. During the visit today, LPA observed new bath towels that were recently purchased. LPA interviewed 9 residents and 8 of them stated that staff will provide towels for showers and will get extra upon request.

Allegation - Staff do not treat resident with respect and dignity. Staff interviewed stated that they show dignity and respect to residents. They are careful with the things they say and will explain to residents calmly when situations arise. They listen to resident concerns and will address the matter. Staff stated sometimes they need to be firm with residents but not done in a way to disrespect them. LPA interviewed 9 residents, and none felt mistreated. They stated that staff are respectful and show dignity. They do not have any concerns with staff treatment.

(Continue on LIC9099C)

SUPERVISOR'S NAME: Tony Vasallo	TELEPHONE: (323) 981-3977
LICENSING EVALUATOR NAME: Cynthia D Chan	TELEPHONE: (323) 981-3370
LICENSING EVALUATOR SIGNATURE:	DATE: 08/31/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/31/2023

LIC9099 (FAS) - (06/04)

Page: 2 of 3

Control Number 28-AS-20230717153428

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: 08/31/2023

NARRATIVE

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Allegation - Staff took resident’s debit card. It was alleged that staff took Resident #1’s (R-1) debit card and then returned it a few days later. Per interview with the Assistant Administrator (AA), R-1 had lost the debit card multiple times and offered to keep the card in the office starting in July 2023. R-1 accepted the offer and AA kept the card in the office safe. Nobody had access to it besides AA. AA stated that when R-1 wanted money, resident came to the front and request for the card. The card was provided upon request. Per AA, after this incident, they started having R-1 sign in and out when the debit card is taken. Staff interviewed denied ever taking a debit card from any resident room. Staff stated that if they see a card on the floor, they will return it to the resident right away. 8 out of 9 interviews with the residents indicated that staff have never taken any debit or credit cards from them.

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.

An exit interview was conducted with Alex Solorio. A copy of this report along with the appeal rights were provided.

SUPERVISOR'S NAME: Tony Vasallo	TELEPHONE: (323) 981-3977
LICENSING EVALUATOR NAME: Cynthia D Chan	TELEPHONE: (323) 981-3370
LICENSING EVALUATOR SIGNATURE:	DATE: 08/31/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/31/2023

LIC9099 (FAS) - (06/04)

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