198603384-5-11-2021-28-AS-CYEE-C764G9-20210923190507

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198603384
Report Date: 05/03/2021
Date Signed: 05/11/2021 12:21:09 PM

Substantiated

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
04/22/2021 and conducted by Evaluator Christine Wong

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20210422081925

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: 129	DATE:	05/03/2021
		UNANNOUNCED	TIME BEGAN:	11:24 AM
MET WITH:	Maria Alarcon		TIME COMPLETED:	12:20 PM

ALLEGATION(S):

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Residents are not being changed timely due to lack of staff

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Christine Wong initiated a subsequent complaint investigation to deliver findings on the allegation listed above. Due to the situation surrounding the Coronavirus Disease 2019 (COVID-19), and to implement mitigation measures, today’s complaint investigation was conducted telephonically with Business Office Director Maria Alarcon.

The investigation consisted of the following: On 4/22/21, LPA conducted the initial 10 days complaint and the administrator, Staff#1 (S1) and 13 residents (R1-R13) were interviewed and LPA received documents included residents and staff rosters that requested from facility. On April 27 and 28, 2021, LPA interviewed additional ten staff (S2-S10).

The investigation revealed of the following: regarding allegation “Residents are not being changed timely due to lack of staff.”
(See LIC9099C Continuation)

Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Christine Yee	TELEPHONE: (323) 981-3978
LICENSING EVALUATOR NAME: Christine Wong	TELEPHONE: (323) 981-3963
LICENSING EVALUATOR SIGNATURE:	DATE: 05/03/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/03/2021

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-20210422081925

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: 05/03/2021

NARRATIVE

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LPA interviewed residents and they reported they realized the facility has short staff recently and staff took longer time to assist them with their needs. It may be taken about 25 minutes to an hour. LPA interviewed staff, and all stated that they are very short staff lately. The assisted living floor used to have about 4-5 caregivers but now there is only one or two caregivers on the floor. They are very overwhelmed and tired; the residents were also very upset with the staff as it took longer time to assist the residents with showering, changing or escorting them to the dining room…etc. Staff reported they spoke to the management, but nothing had improved or changed. The facility was placed with a staffing agency, but they only came for one or two days and it did not help at all. Based on the interviews obtained, the allegation is SUBSTANTIATED.

Based on the interviews conducted, the preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED

California Code of Regulations, Title 22, Division 6 and Chapter 8 was cited. See LIC 9099D.

A telephonic exit interview was conducted with the Business Office Director Maria Alarcon and a hard copy was provided via email for signature.

SUPERVISOR'S NAME: Christine Yee	TELEPHONE: (323) 981-3978
LICENSING EVALUATOR NAME: Christine Wong	TELEPHONE: (323) 981-3963
LICENSING EVALUATOR SIGNATURE:	DATE: 05/03/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/03/2021

LIC9099 (FAS) - (06/04)

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Control Number 28-AS-20210422081925

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
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 05/03/2021

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Request Denied Type B 05/17/2021 Section Cited CCR 87411(a)	1 2 3 4 5 6 7	87411 PErsonnel Requirements-General(a) (a) Facility personnel shall at all times be sufficient in numbers, and competent to provide the services necessary to meet resident needs. The requirment is not met as evidenced by	1 2 3 4 5 6 7	The administrator will ensure facility personnel shall at all times be sufficient in numbers and provide the services necessary to meet resident’s needs. The administrator will send LPA a plan how the facility ensure personnel shall at all times be sufficient in numbers by POC due date
	8 9 10 11 12 13 14	LPA’s interview and reported residents had to wait for 25mints to an hour to be assisted and facility usually has about 4-5 caregivers on one floor but now there’s only one or two on the floor which pose a potential health and safety risk to residents in care	8 9 10 11 12 13 14
	1 2 3 4 5 6 7		1 2 3 4 5 6 7
	1 2 3 4 5 6 7		1 2 3 4 5 6 7

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

SUPERVISOR'S NAME: Christine Yee	TELEPHONE: (323) 981-3978
LICENSING EVALUATOR NAME: Christine Wong	TELEPHONE: (323) 981-3963
LICENSING EVALUATOR SIGNATURE:	DATE: 05/03/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/03/2021

LIC9099 (FAS) - (06/04)

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