198603286-9-21-2021-28-AS-WSHO-C7LLCY-20211008083908

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198603286
Report Date: 09/21/2021
Date Signed: 09/21/2021 01:22:43 PM

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
09/20/2021 and conducted by Evaluator Joe Katrdzhyan

COMPLAINT CONTROL NUMBER: 28-AS-20210920110503

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: 41	DATE:	09/21/2021
		UNANNOUNCED	TIME BEGAN:	08:30 AM
MET WITH:	Assistant Administrator / Alexander Solorio		TIME COMPLETED:	01:30 PM

ALLEGATION(S):

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Resident was sexually abused while in care.

INVESTIGATION FINDINGS:

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Licensing Program Analysts (LPAs) Joe Katrdzhyan and Luis Mora conducted an unannounced 10 day complaint visit to this facility. Upon arriving at the facility, LPAs met with Assistant Administrator / Alexander Solorio who assisted with the visit. LPA Katrdzhyan explained the purpose of today’s visit is to discuss the above mentioned allegation of "Resident was sexually abused while in care".

During today's visit, LPA conducted interviews of various persons to include the Assistant Administrator, Residents 1 through 3 (R1 - R3) and Staff #1. LPA attempted to interview Staff 2 via telephone but was unsuccessful.

The investigation revealed the following;
Allegation: Resident was sexually abused while in care. The details of this allegation states that on 9/9/21, R1 was sexually assaulted by R2, while she lay in her bed.
(Please see LIC 9099C for additional information)

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Wei Siew Ho	TELEPHONE: (323) 981-3969
LICENSING EVALUATOR NAME: Joe Katrdzhyan	TELEPHONE: (323) 981-3968
LICENSING EVALUATOR SIGNATURE:	DATE: 09/21/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/21/2021

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-20210920110503

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: 09/21/2021

NARRATIVE

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Statements obtained from R1 by facility Staff, Law Enforcement and Community Care Licensing regarding the time/date and details of the alleged incident were inconsistent and changed during the course of the investigation. There were no witnesses to the alleged incident. R2 denied making sexual advances towards R1. From the interviews conducted, LPA learned that R1 has a history of making false allegations towards residents and staff. R1 and R2 used to be friends and have been observed by staff in the past hanging around in R1's room watching TV and talking. R1 is in the process of being evicted from the facility for being non-compliant with facility house rules. Pasadena Police Department also conducted an investigation regarding the alleged incident and it was determined that no crime had occurred. Based on interviews conducted, there is insufficient evidence to concur with the reported allegation.

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.

An exit interview was conducted and a copy of this report was provided to the Assistant Administrator.

SUPERVISOR'S NAME: Wei Siew Ho	TELEPHONE: (323) 981-3969
LICENSING EVALUATOR NAME: Joe Katrdzhyan	TELEPHONE: (323) 981-3968
LICENSING EVALUATOR SIGNATURE:	DATE: 09/21/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/21/2021

LIC9099 (FAS) - (06/04)

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