198603295-3-28-2022-28-AS-MVAO-CDEUY6-20220412155926

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198603295
Report Date: 03/28/2022
Date Signed: 03/28/2022 12:09:21 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
03/02/2020 and conducted by Evaluator Joe Katrdzhyan

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20200302141607

FACILITY NAME:	PASA ALTA MANOR		FACILITY NUMBER:	198603295
ADMINISTRATOR:	CHERTOK, VLADIMIR		FACILITY TYPE:	735
ADDRESS:	1790 N FAIR OAKS AVENUE		TELEPHONE:	(626) 789-6986
CITY:	PASADENA	STATE: CA	ZIP CODE:	91103
CAPACITY:	90	CENSUS: 83	DATE:	03/28/2022
		UNANNOUNCED	TIME BEGAN:	08:45 AM
MET WITH:	Facility Manager / Tricia Pedroza		TIME COMPLETED:	12:30 PM

ALLEGATION(S):

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Client not accorded with dignity by staff.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Joe Katrdzhyan conducted an unannounced follow up visit to this facility to deliver findings on the above mentioned allegation of "Client not accorded with dignity by staff". Upon arriving at the facility, LPA met with Facility Manager / Tricia Pedroza who assisted with the visit.

LPA Katrdzhyan conducted a prior visit to this facility on 3/11/2020, in reference to the allegation listed above. The investigation consisted of interviews of various persons to include the Facility Manager and Client #1 (C1). LPA attempted to interview the Service Coordinator at North Los Angeles County Regional Center (NLACRC) but was unsuccessful. Also, copies of the following documents were obtained and reviewed in reference to C1;

• Client Information Sheet • Admission Agreement • Physician's Report • Emails between Facility Manager and North Los Angeles County Regional Center (NLACRC)

Please see LIC 9099C for additional information.

Unsubstantiated

Estimated Days of Completion:

NAME OF LICENSING PROGRAM MANAGER: Wei Siew Ho
NAME OF LICENSING PROGRAM ANALYST: Joe Katrdzhyan
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 03/28/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/28/2022

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-20200302141607

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: PASA ALTA MANOR	FACILITY NUMBER: 198603295
	VISIT DATE: 03/28/2022

NARRATIVE

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The investigation revealed the following;
Allegation: Client not accorded with dignity by staff. The details of this allegation states that prior to a change
of ownership at the facility, C1's fees were being paid by NLACRC, but the new Licensee does not have a contract with NLACRC and NLACRC is trying to find placement for C1. Facility staff were pressuring C1 to sign a document stating that he will be moving out of this facility. Then staff at facility tried to force C1 into taking a TB test and C1 refused when C1 found out that a staff would be administering the test and not a medical professional. The facility staff maybe retaliating against C1 or forcing him out of facility.

Based on record reviews and interviews conducted, LPA discovered that Pasa Alta Manor went through a change of ownership on 12/23/2019. The new Licensee, Pasa Alta Holdings, Inc. was not vendorized through NLACRC and therefore no rent was being paid by NLACRC on behalf of C1. Based on chain of emails between NLACRC and the Facility Manager, Pasa Alta Manor was planning to issue an eviction notice to C1 for nonpayment of rent. An eviction notice was not issued to C1. Pasa Alta Manor, along with NLACRC attempted to schedule a TB test for C1 (through a medical professional) as there was none on file and C1 needed a current TB test in order for NLACRC to find placement for C1 in a vendored Community Care Facility. The Facility Manager denied retaliation or forcing to move C1 out of the facility. Pasa Alta Manor and NLACRC were in agreement of finding placement for C1 in a vendored Community Care Facility. During the visit conducted on 3/28/22, LPA conducted an interviewed of C1 (via telephone) and was told that there was no form of retaliation from facility staff at Pasa Alta Manor and C1 felt that way based on the situation and how things were in 2020. C1 was refusing to take the TB test because C1 did not wish to relocate to a new facility. Since March of 2020, C1 and Pasa Alta Manor have worked out a payment agreement and C1 continues to resides at Pasa Alta Manor and is happy to live there.
Based on the information gathered, there is insufficient evidence to support the allegation of "Client not accorded with dignity by staff".

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 Facility Manager.

NAME OF LICENSING PROGRAM MANAGER: Wei Siew Ho
NAME OF LICENSING PROGRAM ANALYST: Joe Katrdzhyan
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 03/28/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/28/2022

LIC9099 (FAS) - (06/04)

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