198603416-1-11-2023-28-AS-RORN-CPWVFF-20230314162352

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198603416
Report Date: 01/11/2023
Date Signed: 01/11/2023 07:51:57 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
01/06/2023 and conducted by Evaluator Bennette Pena

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20230106092955

FACILITY NAME:	MORNINGSTAR OF PASADENA		FACILITY NUMBER:	198603416
ADMINISTRATOR:	TALIAFERRO, KEVIN		FACILITY TYPE:	740
ADDRESS:	951 S. FAIR OAKS AVENUE		TELEPHONE:	(626) 204-1700
CITY:	PASADENA	STATE: CA	ZIP CODE:	91105
CAPACITY:	310	CENSUS: 136	DATE:	01/11/2023
		UNANNOUNCED	TIME BEGAN:	09:45 AM
MET WITH:	Executive Director, Kevin Taliaferro		TIME COMPLETED:	04:15 PM

ALLEGATION(S):

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Facility staff did not properly supervise residents resulting in multiple falls.
Facility staff did not properly store food causing residents to food poisoning.
Facility staff not assisting residents in a timely manner.
Facility staff not providing resident with meals in a timely manner.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Bennette Pena made an unannounced visit to the facility to investigate the above allegations. LPA was greeted by the Executive Director, Kevin Taliaferro and discussed the purpose of today’s visit.

The investigation consisted of the following: LPA obtained copies of the staff/resident roster, regular weekly menus/daily specials, kitchen staff weekly schedule and assignments. LPA obtained information regarding training on food handling techniques and procedures which includes set up, meal service, food preparation, universal precautions, hygiene and dietary standards with all food service staff. LPA reviewed Resident's #1-#2 (R1-R2) files (Admission Agreement, Emergency I.D. and Information, Physician's Report, Appraisal/Needs and Services Plan, Physician's orders). LPA interviewed (8) staff including the Administrator, (11) residents, toured the facility including kitchen for the ability to prepare and serve food. LPA observed that the kitchen staff were wearing masks and gloves during set up and procedure. LPA also observed an appropriate food supply of two (2) days of perishables and one week (7 days) of non-perishables.

Refer to LIC 9099C for the continuation of this report.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: David Sicairos	TELEPHONE: (323) 981-3982
LICENSING EVALUATOR NAME: Bennette Pena	TELEPHONE: (323) 981-3307
LICENSING EVALUATOR SIGNATURE:	DATE: 01/11/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/11/2023

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 5

Control Number 28-AS-20230106092955

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: MORNINGSTAR OF PASADENA	FACILITY NUMBER: 198603416
	VISIT DATE: 01/11/2023

NARRATIVE

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Regarding allegation: Facility staff did not properly supervise residents resulting in multiple falls.
During this investigation, LPA obtained relevant documentation and interviewed staff and residents. (6) out of (8) staff interviews revealed there is sufficient staff supervision. S1 stated that the staff ratio is (1) caregiver per 5-7 residents per shift. S1 indicated that facility provides balance exercises daily for free. And facility has (3) physical therapists available for residents to help with improving their health and balance. Staff interviews revealed that staff conduct rounds every (2) two hours and as needed throughout the entire day. Interviewed staff indicated rounds are documented on a chart with the resident’s names, dates, times and staff conducting the rounds. (6) out of (8) staff indicated that they have not seen any falls or slips during their shift. (7) out of (8) staff indicated that they have not received any complaints nor concerns in regards to residents falling from any resident representatives/family members, staff nor residents. LPA reviewed R1-2 documents which indicated that they both use a walker but none of them have a history or high risk of falls. Interviewed residents indicated staff conduct rounds often throughout the entire day. (2) residents interviewed stated that they had slipped because of their health condition and not because of the staff. And they did not suffer any injuries due to the fall or slip. (9) out of (11) interviewed residents indicated that they have not fallen nor they have witnessed anyone falling. Documentation reviewed and interviews conducted with staff and residents do not corroborate this allegation.

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.

SUPERVISOR'S NAME: David Sicairos	TELEPHONE: (323) 981-3982
LICENSING EVALUATOR NAME: Bennette Pena	TELEPHONE: (323) 981-3307
LICENSING EVALUATOR SIGNATURE:	DATE: 01/11/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/11/2023

LIC9099 (FAS) - (06/04)

Page: 3 of 5

Control Number 28-AS-20230106092955

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: MORNINGSTAR OF PASADENA	FACILITY NUMBER: 198603416
	VISIT DATE: 01/11/2023

NARRATIVE

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Regarding allegation: Facility staff did not properly store food causing residents to food poisoning.
At 10:05am, LPA toured the kitchen and observed the staff wearing hair nets, masks and gloves. The food was being prepared by the chef and (1) kitchen worker cleaning the surrounding areas. There were servers delivering the food trays (wrapped) to the rooms. The food served to the residents came straight from the kitchen for those residents eating in their own room. LPA obtained a copy of the daily specials/weekly menu which included different items from each food group. Staff interviewed stated that the kitchen workers were trained in food handling, preparation, universal precautions, hygiene and dietary standards. (7) out of (8) staff indicated that they have not seen anything unusual or improper in the food preparation in the kitchen. S1 denied the allegation and stated that per their investigation, the GI outbreak they had was not from the food in the facility but elsewhere. S6 stated that the food poisoning incident started outside the facility and it started going around but not because of the food in the kitchen. S3 stated that he conducts stand up training daily to the kitchen staff regarding food handling, how to serve the food, precautionary measures and proper food storage and labeling. All (11) residents interviewed stated that they are happy with the food and had no complaints. When they order food to be delivered in their room, they get it in about 1/2 hour or so and still hot or warm when delivered. (11) Residents indicated that hot drinks, like coffee, tea are readily available in the dining area. And all (11) residents never had any illnesses due to the food they ate in the facility. Staff interviews, resident interviews and LPA's observations do not corroborate this allegation.

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.

SUPERVISOR'S NAME: David Sicairos	TELEPHONE: (323) 981-3982
LICENSING EVALUATOR NAME: Bennette Pena	TELEPHONE: (323) 981-3307
LICENSING EVALUATOR SIGNATURE:	DATE: 01/11/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/11/2023

LIC9099 (FAS) - (06/04)

Page: 2 of 5

Control Number 28-AS-20230106092955

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: MORNINGSTAR OF PASADENA	FACILITY NUMBER: 198603416
	VISIT DATE: 01/11/2023

NARRATIVE

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Regarding allegation: Facility staff not assisting residents in a timely manner.
Interviews revealed that there are enough staff to assist with the residents needs. S1 stated that there is (1) caregiver assigned to 5-7 residents per shift. (5) out of (8) staff interviewed stated that there are (3) caregivers assisting residents per shift. S2, S4-S6 stated that the facility provided them with a company phone and when the resident press their call button/pendant, they get the call right away on their phones. They never had an issue with the phone reception so assistance is given within 5-10 mins. If one (1) of them is giving showers or unable to go to the resident when they call, the other caregivers on shift will step in to assist with the residents' calls. Staff stated that they do regular rounds, every 2 hours or less if needed. They have a system where they document the activities/incidents on a chart which was done electronically on the phone. (6) staff stated that residents want assistance at once when they call for help. They indicated that some residents think that they are waiting for a long time, but in reality, it was only 5-10 mins wait. Residents interviewed stated that they do not wait long to get assistance. Some of the residents who use the call button/pendant stated that wait times vary, between 5-30 mins which were acceptable to them. Some residents also use the phone to call the front desk for assistance. Interviews conducted with residents and staff do not corroborate the allegation.

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.

SUPERVISOR'S NAME: David Sicairos	TELEPHONE: (323) 981-3982
LICENSING EVALUATOR NAME: Bennette Pena	TELEPHONE: (323) 981-3307
LICENSING EVALUATOR SIGNATURE:	DATE: 01/11/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/11/2023

LIC9099 (FAS) - (06/04)

Page: 4 of 5

Control Number 28-AS-20230106092955

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: MORNINGSTAR OF PASADENA	FACILITY NUMBER: 198603416
	VISIT DATE: 01/11/2023

NARRATIVE

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Regarding allegation: Facility staff not providing resident with meals in a timely manner.
(7) out of (8) staff interviewed denied the allegation and stated that there are enough staff working in the kitchen per shift. S1 stated that some residents complain because the facility charges extra if food is delivered to their room, except when the resident is sick. (7) out of (8) staff stated that food is delivered to the residents room in a timely manner. If food order is received by 11am, the food is delivered to them between 30-40 mins and delivered hot and fresh. S3 and S7 stated that there are (4) servers per shift, (1) server assigned per floor. They also stated that they have food runners in addition to servers and they stand as back up for servers. S7 indicated that the residents who order food to be delivered in the room are prepared first, before all the residents arrive in the dining room. The hot food is stored in hot boxes and delivered to the rooms right away. S3 and S7 stated that hot beverages are readily available in the dining area and residents can make/get their own. (11) residents interviewed stated that they do not have any issues with the meals being delivered in a timely manner. Most of them go to the dining room to eat and socialize. Some have their lunch delivered in the room and they get it on time.

Based on statements and interviews conducted with residents and staff, there was not enough supportive evidence to corroborate the allegation.

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.

Exit interview and a copy of this report were provided to the Executive Director, Kevin Taliaferro.

SUPERVISOR'S NAME: David Sicairos	TELEPHONE: (323) 981-3982
LICENSING EVALUATOR NAME: Bennette Pena	TELEPHONE: (323) 981-3307
LICENSING EVALUATOR SIGNATURE:	DATE: 01/11/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/11/2023

LIC9099 (FAS) - (06/04)

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