198603295-7-5-2022-28-AS-RORN-CUAPSJ-20230801113423

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198603295
Report Date: 07/05/2022
Date Signed: 07/05/2022 03:39:36 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
06/30/2022 and conducted by Evaluator Joe Katrdzhyan

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20220630114339

FACILITY NAME:	PASA ALTA MANOR		FACILITY NUMBER:	198603295
ADMINISTRATOR:	CHERTOK, VLADIMIR		FACILITY TYPE:	735
ADDRESS:	1790 N FAIR OAKS AVENUE		TELEPHONE:	(626) 798-6986
CITY:	PASADENA	STATE: CA	ZIP CODE:	91103
CAPACITY:	90	CENSUS: 81	DATE:	07/05/2022
		UNANNOUNCED	TIME BEGAN:	09:15 AM
MET WITH:	Facility Manager / Tricia Pedroza		TIME COMPLETED:	04:00 PM

ALLEGATION(S):

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Staff members enter residents room uninvited
Staff selling "illegal" cigarettes to residents
Food is not of good quality
Staff are keeping residents P&I monies

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Joe Katrdzhyan conducted an unannounced 10 day complaint visit to this facility. Upon arriving at the facility, LPA met with Facility Manager / Tricia Pedroza who assisted with the visit. LPA Katrdzhyan explained the purpose of today’s visit is to discuss the above mentioned allegations of "Staff members enter residents room uninvited, Staff selling "illegal" cigarettes to residents, Food is not of good quality and Staff are keeping residents P&I monies."

During today's visit, LPA interviewed the Facility Manager, Staff members 1 through 3 (S1 - S3) and Clients 1 through 6 (C1 - C6). LPA toured the facility kitchen and observed the food supply. Also, copies of the following documents were obtained and reviewed;

• Client & Staff Roster • Food Menu for the month

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: 07/05/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/05/2022

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-20220630114339

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: 07/05/2022

NARRATIVE

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The investigation revealed the following;

Allegation: Staff members enter residents room uninvited. The details of this allegation states that Staff go into resident rooms without knocking on the door and sometimes the residents are naked.
Based on interviews conducted, the statements obtained were inconsistent and did not corroborated with the allegation. Staff and residents interviewed denied staff members entering in resident rooms uninvited or without knocking. Staff and residents stated that staff/housekeeping always knocks on resident doors prior to entering the rooms to ensure resident privacy. Based on interviews conducted, there is insufficient evidence to support this allegation to be true.

Allegation: Staff selling "illegal" cigarettes to residents. The details of this allegation states that facility staff are selling cigarettes called "Pit Bull" to residents, which are illegal in the state of California (CA). Staff interviewed denied selling illegal cigarettes to residents. LPA conducted a google search on the internet to verify if "Pit Bull" cigarettes are illegal in the state of CA but was unable to confirm as no related information was found. According to the Facility Manager, residents at this facility have been smoking Pit Bull cigarettes for years and it has never been a concern. Based on interviews conducted and Google search, there is insufficient evidence to support this allegation to be true.

Allegation: Food is not of good quality. The details of this allegation states that the "food is bad" and they serve the same food everyday. Based on interviews conducted, the statements obtained were inconsistent and did not corroborated with the allegation. Staff and residents interviewed denied the food not being of good quality and denied the same food is being served everyday. Staff and residents stated that the meals served are of variety. LPA verified on the menu that the meals served daily are not the same and there is a variety during breakfast lunch and dinner. According to the Facility Manager if a resident refuses a meal, there are alternative meals available to residents. During today's visit, LPA toured the facility kitchen and observed an ample supply of nonperishable foods for a minimum of one week and fresh perishable foods for a minimum of two days. LPA observed meats, fruits, vegetables, eggs, juice, milk and snacks at the facility. Based on interviews conducted, LPA's observation and record review, there is insufficient evidence to support this allegation to be true.

Allegation: Staff are keeping residents P&I monies. The details of this allegations states that staff "pocket" the residents P&I monies.

NAME OF LICENSING PROGRAM MANAGER: Wei Siew Ho
NAME OF LICENSING PROGRAM ANALYST: Joe Katrdzhyan
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 07/05/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/05/2022

LIC9099 (FAS) - (06/04)

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Control Number 28-AS-20220630114339

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: 07/05/2022

NARRATIVE

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Based on interviews conducted, the statements obtained were inconsistent and did not corroborated with the
allegation. Staff and residents interviewed denied staff stealing or "pocketing" residents P&I monies. Residents stated that their P&I monies are received timely. Per the Facility Manager, some residents take the entire amount at once and some residents receive their P&I monies in small increments, as the facility helps manage their finances. The facility disburses resident monies twice a week, on Mondays and Thursdays. Based on interviews conducted, there is insufficient evidence to support this allegation to be true.

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 and a copy of this report was provided.

NAME OF LICENSING PROGRAM MANAGER: Wei Siew Ho
NAME OF LICENSING PROGRAM ANALYST: Joe Katrdzhyan
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 07/05/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/05/2022

LIC9099 (FAS) - (06/04)

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