198603286-8-31-2023-28-AS-FFIS-CWBQLU-20231005121628

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198603286
Report Date: 08/31/2023
Date Signed: 08/31/2023 02:55:14 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
08/25/2023 and conducted by Evaluator Ashley Calderon

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20230825140302

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:	09:25 AM
MET WITH:	Assistant Administrator- Alexander Solorio		TIME COMPLETED:	03:00 PM

ALLEGATION(S):

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Facility staff did not safeguard resident's personal belongings

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Ashley Calderon conducted a visit in response to the above allegation. On today's visit, LPA met with Assistant Administrator Alexander Solorio and discussed the purpose of today's visit.

On today's visit, LPA collected resident and staff roster. Collected Resident #1 (R1) Physician Report, Face sheet, Appraisal Needs and Service Plan and Admission Agreement. LPA collected R1-R8's client/resident personal and valuables (LIC 621) and Pasadena Villa Senior Living Policy and Procedures regarding Theft and Loss Prevention. LPA toured random rooms of residents rooms: 3,8,14,21,22,24,29 and 31. LPA interview Residents #1-8 (R1-R8) and staff, Assistant Administrator and Staff #1-#4 (S1-S4). LPA interviewed an Officer from the Pasadena Police Department who was present during LPA's visit, incident number provided: #23-72282. (Continuation on 9099-C...)

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Fernando Fierros	TELEPHONE: (323) 981-3981
LICENSING EVALUATOR NAME: Ashley Calderon	TELEPHONE: (323) 981-3984
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-20230825140302

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: 08/31/2023

NARRATIVE

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Regarding Allegation: Facility staff did not safeguard resident's personal belongings. LPA interviewed staff Assistant Administrator, and Staff, S1-S4 during interviews with staff the following was revealed: Staff denied facility not safeguarding residents belongings. Assistant Administrator ,S1-S3 stated facility has a locked space in the front office if resident's choose to have their personal items inventoried. Interviews with Assistant Administrator and S1-S4 stated facility assist residents if and when things are misplaced, stolen or missing and resident's have their own space for personal belongings. LPA interview with Assistant Administrator and S2-S4 stated facility has camera footage to review if resident(s) has a concern regarding personal belongings. LPA interview with residents revealed: R1-R8 denied the above allegation regarding facility not safeguarding resident's personal belongings. 8 out of 8 residents stating their belongings are safeguarded at the facility. R1 during interview revealed not being certain if their roommate steals their monies and did not have an issue with facility not safeguarding R1's personal belongings. LPA interview Officer from Pasadena Police Department, officer was investigating the allegation listed above. Officer from Pasadena Police Department stated speaking to R1 and R1 stated there wasn't any issue with R1's roommate or no issues with facility not safeguarding resident's personal belongings including monies. LPA reviewed residents inventory list and facilities Policy and Procedures regarding Theft and Loss prevention that is located in the facility Admission Agreement and provided to each resident upon admission. LPA reviewed facilities Policy and Procedures regarding Theft and Loss prevention for the following residents R1-R8, showing residents denied having their personal items inventoried. LPA Calderon observed random rooms of residents and observed each resident having adequate / required furniture per Title 22 for personal belongings. LPA observed front office having a secured space for safeguarding resident's belongings if a resident choices for personal items to be inventoried. Therefore, based on interviews, record review and observations there was insufficient evidence to corroborate with this allegation.

Based on LPA's interviews, observations and record review 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 Assistant Administrator Alexander Solorio.

SUPERVISOR'S NAME: Fernando Fierros	TELEPHONE: (323) 981-3981
LICENSING EVALUATOR NAME: Ashley Calderon	TELEPHONE: (323) 981-3984
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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