198603295-6-17-2023-28-AS-RORN-CT2ULT-20230622154117

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198603295
Report Date: 06/17/2023
Date Signed: 06/17/2023 01:43:01 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
11/19/2021 and conducted by Evaluator Luis Mora

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20211119160110

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: 84	DATE:	06/17/2023
		UNANNOUNCED	TIME BEGAN:	01:00 PM
MET WITH:	Brenda Quiroz - Med-Tech		TIME COMPLETED:	01:30 PM

ALLEGATION(S):

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Staff allow residents to use drugs inside the facility that may result in felony offenses.

INVESTIGATION FINDINGS:

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This complaint was investigated by Investigator Christine Ferris. Licensing Program Analyst (LPA) Luis Mora conducted an unannounced follow up visit to this facility to assist Licensing Program Analyst (LPA) Joe Katrdzhyan with delivering findings. Upon arriving at the facility, LPA met with Brenda Quiroz (Med-Tech) who assisted with the visit. The allegation listed on this complaint states, “Staff allow residents to use drugs inside the facility that may result in felony offenses.”

Prior visits were conducted at this facility on 11/22/21 and 11/30/21 in reference to the allegation listed above. During the course of the investigation, interviews were conducted by Investigator Ferris with various persons to include the Administrator and Clients 1 and 2 (C1 and C2).

The investigation revealed the following;
Allegation: Staff allow residents to use drugs inside the facility that may result in felony offenses.
(Continued to LIC 9099-C)

Unsubstantiated

Estimated Days of Completion:

NAME OF LICENSING PROGRAM MANAGER: Wei Siew Ho
NAME OF LICENSING PROGRAM ANALYST: Luis Mora
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 06/17/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/17/2023

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-20211119160110

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: 06/17/2023

NARRATIVE

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Based on interviews conducted, there is insufficient evidence to show there is illegal drug usage at the facility. Witnesses have no knowledge of illegal drug usage on the premises and confirmed the facility conducts random drug tests and room checks to help prevent such usage. The Administrator, reasonably explained that majority of the clientele at the facility have a history of illegal drug usage and may use illegal drugs while away from the premises, but random drug tests and room checks help prevent illegal drugs from entering the facility and staff is diligent in preventing illegal drug usage within the facility. The Administrator stated that she has no knowledge of illegal drug usage at the facility nor has she been advised of such. Based on the investigation conducted by Investigator Ferris, there is insufficient evidence to support the above-mentioned allegation to be true.

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 Administrator.

NAME OF LICENSING PROGRAM MANAGER: Wei Siew Ho
NAME OF LICENSING PROGRAM ANALYST: Luis Mora
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 06/17/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/17/2023

LIC9099 (FAS) - (06/04)

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