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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198603295
Report Date: 03/14/2023
Date Signed: 03/14/2023 03:06:06 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
03/07/2023 and conducted by Evaluator Bennette Pena
COMPLAINT CONTROL NUMBER: 28-AS-20230307105400
FACILITY NAME:PASA ALTA MANORFACILITY NUMBER:
198603295
ADMINISTRATOR:CHERTOK, VLADIMIRFACILITY TYPE:
735
ADDRESS:1790 N FAIR OAKS AVENUETELEPHONE:
(626) 798-6986
CITY:PASADENASTATE: CAZIP CODE:
91103
CAPACITY:90CENSUS: 83DATE:
03/14/2023
UNANNOUNCEDTIME BEGAN:
09:33 AM
MET WITH:Administrator, Tricia PedrozaTIME COMPLETED:
03:00 PM
ALLEGATION(S):
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Staff mismanaged client's funds
Staff harassed client in care
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Bennette Pena conducted an initial complaint visit to investigate the above allegations. LPA met with the Administrator, Tricia Pedrosa and explained the purpose of the visit today.

During today's visit, LPA obtained a copy of the staff roster and client roster. LPA reviewed Client #1's (C-1) file and obtained copies of Face Sheet, Admission Agreement, House Rules, Appraisal Needs and Services Plan, Physician Report, Incident reports (Jan 2023-Mar 2023), Electronic messages (Email/Text) between Administrator, C1, and other repesentatives and 30-day Eviction Notice dated 3/01/2023. Interviews were conducted with Staff #1 – Staff #4 (S-1 through S-4), and Client #1 - Client #8 (C-1 through C-8).
***CONTINUED ON LIC9099 C***
Unsubstantiated
Estimated Days of Completion:
NAME OF LICENSING PROGRAM MANAGER: David Sicairos
NAME OF LICENSING PROGRAM ANALYST: Bennette Pena
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 03/14/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/14/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 2
Control Number 28-AS-20230307105400
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: PASA ALTA MANOR
FACILITY NUMBER: 198603295
VISIT DATE: 03/14/2023
NARRATIVE
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The investigation revealed the following:

Allegation: “Staff mismanaged client's funds.” It is alleged that client began receiving SSI payments, which facility wanted to go to them. And that client never received any documents of what has been paid for his rent and what he owes them if anything. During today’s visit, LPA reviewed C-1's file and revealed that C-1 had a rental payment arrangement with the previous owner where C-1 will only pay a portion of his rental fee. However, records (letter dated 11/16/2022) showed that this payment arrangement and assistance had stopped. S1 denied the allegation of mismanaging C-1's funds because C-1 has been receiving SSI benefits and he is his own payee. LPA reviewed the facility's rent roster rom Dec. 2022 - Feb 2023 and revealed that C-1 paid the facility $400 in Dec. 2022 and has not paid his rent since. S1-S2 stated that they have been assisting and working with a payment plan with C-1 to be able to pay his rent but he continues to refuse to pay although he is receiving SSI money. Records showed that S1 issued a 30-day eviction letter dated 3/01/2023 due to failure to pay rent based on C-1's lease agreement. The letter was provided to C-1 and his representatives but C-1 refused to sign and accept it. Interviews with S2-S4 indicated that C-1 has behavioral issues, not compliant and does not follow the house rules. (7) out of (8) clients interviewed stated that they pay their rent on schedule every month. Some clients have public guardians who assist them in paying rent. All (7) clients stated that they get they P & I fund when requested and facility gives it to them on schedule, 2x a week, every Mon and Thu. None of them had issues with not receiving their money. Based on file review and interviews, there was not enough supportive evidence to concur with the reported allegation.

Allegation: “Staff harassed client in care.” It is alleged that facility staff begin to harass client forcing him to move out because he could not pay. During this investigation, LPA obtained relevant documentation for Client #1 (C-1) which revealed that C-1 paid $400 on Dec. 2022 towards rent and had not made paid his rent since. S1 stated that the facility has been working with C-1 to assist him get up-to-date with his rent payment like waiving late fees, offering payment plans but C-1 would agree in the beginning and change his mind later on. C-1 still refused to pay his dues despite receiving SSI money. S1 stated that there was a meeting held in Dec. 2022 with C-1 where he wanted the facility to be C1's payee and agreed to set up an appointment with SSA representative. But C-1 cancelled and refused to speak with them during the scheduled meeting with SSA. LPA reviewed the eviction notice (dated 3/01/2023) provided to C-1 and his representatives. C-1 refused to sign and accept the eviction letter. The letter explained the reason for the eviction which was C-1 continually failed to comply with the agreement to pay rent per the lease agreement. Interviews conducted with the staff corroborated S1 statement regarding C-1 agreeing to meet with SSA to assign the facility as his SSI payee, but later cancelling and denying that he agreed to it. Staff interviews revealed that they have not witnessed, nor have they harassed anyone (sexually, physically nor verbally). Staff interviews also revealed they are trained in Mandated Reporting and Client Rights. Client interviews revealed that they have not been harassed (sexually, physically nor verbally) nor have they witnessed anyone being harassed and by others. LPA interviewed clients who were consistent with their statements that they deny ever hearing or seeing staff threatening with eviction and/or harassing clients. Documentation reviewed and interviews conducted do not corroborate this allegation.



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.
NAME OF LICENSING PROGRAM MANAGER: David Sicairos
NAME OF LICENSING PROGRAM ANALYST: Bennette Pena
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 03/14/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/14/2023
LIC9099 (FAS) - (06/04)
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