198603384-2-2-2022-28-AS-SCOL-CC6PHV-20220303102034

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198603384
Report Date: 02/02/2022
Date Signed: 02/02/2022 03:48:35 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
01/25/2022 and conducted by Evaluator Alma Gonzalez

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20220125102408

FACILITY NAME:	PASADENA HIGHLANDS		FACILITY NUMBER:	198603384
ADMINISTRATOR:	CANO, KAY		FACILITY TYPE:	740
ADDRESS:	1575 E WASHINGTON BLVD		TELEPHONE:	(801) 815-0808
CITY:	PASADENA	STATE: CA	ZIP CODE:	91104
CAPACITY:	245	CENSUS: 154	DATE:	02/02/2022
		UNANNOUNCED	TIME BEGAN:	02:30 PM
MET WITH:	Executive Director Brodey De Borde		TIME COMPLETED:	04:00 PM

ALLEGATION(S):

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Staff do not follow resident's Care Plan
Staff do not aid resident with incontinence needs
Staff do not ensure resident's room is not malodorous

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Alma Gonzalez conducted an unannounced complaint visit to gather information pertaining to the above-mentioned allegations. LPA met with Executive Director Brodey De Borde and explained the reason for the visit.

The investigation consisted of: LPA Alma Gonzalez conducted an interview with Executive Director Brodey De Borde, Health and Wellness Director Laura Sanchez, Assisted Living Director Sanda Lee, and Corporate Health and Wellness Director Kay Cano. LPA and Executive Director De Borde toured a random number of resident rooms (201, 220, 222, 519 and 526). LPA additionally requested and received current copies of Staff and Resident Rosters. LPA additionally requested and received copies of Resident Rosters for the months of November 2021 - January 2022.

(See LIC9099C for continuation)

Unfounded

Estimated Days of Completion:

SUPERVISOR'S NAME: Rebecca Orendain	TELEPHONE: (323) 981-3961
LICENSING EVALUATOR NAME: Alma Gonzalez	TELEPHONE: (323) 981-3370
LICENSING EVALUATOR SIGNATURE:	DATE: 02/02/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/02/2022

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-20220125102408

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 HIGHLANDS	FACILITY NUMBER: 198603384
	VISIT DATE: 02/02/2022

NARRATIVE

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Investigation revealed the following: Regarding allegations of, Staff do not follow resident's Care Plan,
Staff do not aid resident with incontinence needs, and Staff do not ensure resident's room is not malodorous, it is alleged that R1's diaper is soaked in urine every time R1 gets a visit. R1's bedding and clothing are soaked in urine, and room smells of urine. It is also alleged that R1 is kept in their wheelchair all day, and is not taken to the restroom every 2 hours as stated in their Care Plan. R1's monthly rate is $4000.00 which includes the service of staff providing that type of care for resident.

Interview with Executive Director Brodey De Borde revealed that R1 is not a resident of the facility and has not been a resident of the facility. Interview with Health and Wellness Director Laura Sanchez revealed that R1 has never been a resident of the facility. Interview with Assisted Living Director Sanda Lee revealed that R1 has never been a resident of the facility. Interview with Corporate Health and Wellness Director Kay Cano also revealed that R1 is not a resident of the facility and has not been a resident of the facility. Executive Director Brodey De Borde stated that there have not been any current concerns brought up from anyone about staff not following a resident's Care Plan, or staff not providing aid to a resident with incontinence needs. Mr. De Borde also stated that resident's rooms are cleaned on a daily basis and as needed and there is not any resident room that smells of urine or is malodorous. LPA toured a random number of resident rooms and observed resident rooms to be clean, smell clean and observed residents to be clean. LPA also observed staff cleaning rooms on the second floor. LPA review of resident rosters for the months of November 2021 - January 2022 revealed that R1 is not a current resident and was not a resident of the facility. Based on LPA interviews with facility staff, LPA observations and LPA review of documentation which revealed that R1 is not a resident and has not been a resident of the facility, LPA Gonzalez determined that there was insufficient evidence to support the above stated allegations.

This agency has investigated the complaint alleging, Staff do not follow resident's Care Plan,
Staff do not aid resident with incontinence needs, and Staff do not ensure resident's room is not malodorous. We have found that the complaint was UNFOUNDED, meaning that the allegations were false, could not have happened and/or are without reasonable basis. We have therefore dismissed the complaint.

Exit interview held. A copy of the report was provided to Executive Director Brodey De Borde.

SUPERVISOR'S NAME: Rebecca Orendain	TELEPHONE: (323) 981-3961
LICENSING EVALUATOR NAME: Alma Gonzalez	TELEPHONE: (323) 981-3370
LICENSING EVALUATOR SIGNATURE:	DATE: 02/02/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/02/2022

LIC9099 (FAS) - (06/04)

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