198603416-9-2-2023-28-AS-TVAO-CVVUHT-20230921153624

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198603416
Report Date: 09/02/2023
Date Signed: 09/02/2023 02:04:47 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
08/25/2023 and conducted by Evaluator Kimberly Ramirez

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20230825143327

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: 152	DATE:	09/02/2023
		UNANNOUNCED	TIME BEGAN:	01:06 PM
MET WITH:	Kevin Taliaferro		TIME COMPLETED:	02:00 PM

ALLEGATION(S):

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Staff not providing resident(s) with services that are paid for.
Staff not providing resident(s) with admissions agreement.
Staff not responding to resident(s) call button.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Kimberly Ramirez conducted an unannounced subsequent complaint investigation visit on 09/02/23 regarding the above allegations. Intial 10-day visit was conducted on 8/31/2023 and needs further was required. LPA Ramirez was met by Administrator Taliaferro and explained the purpose of the visit.

The investigation consisted of the following: LPA Ramirez requested and obtained copies of Staff Roster (LIC 500), Resident Roster (LIC 9020), Staff #1 - 3 interviews (S1 – S3), Resident #1-4 interviews (R1 – R4 ), copies of Resident #1 (R1): Care Reports for the month of August 2023, Admissions Agreement, other pertinent documents related to this investigation and physical plant tour.

See 9099-C for continuation.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Tony Vasallo	TELEPHONE: (323) 981-3977
LICENSING EVALUATOR NAME: Kimberly Ramirez	TELEPHONE: (323) 981-3970
LICENSING EVALUATOR SIGNATURE:	DATE: 09/02/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/02/2023

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-20230825143327

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: 09/02/2023

NARRATIVE

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The investigation revealed the following. Regarding Allegation(s): Staff not providing resident(s) with services that are paid for. It is alleged residents are not receiving the services they are paying for. Three (3) out of the three (3) staff interviewed deny this allegation. Four (4) out of the four (4) residents interviewed deny this allegation. At 1:22 pm, LPA Ramirez reviewed and obtained copies of Resident#1 (R1) care report for the month of August 2023. LPA Ramirez reviewed R1’s Admission Agreement and payment schedule. R1 was admitted into in the facility on 11/21/22. LPA Ramirez could not find any discrepancies during review of these documents. Review of R1’s care report for August of 2023, revealed staff documented completed tasks and services that R1 pays for based on R1’s level of care. 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.

Staff not providing resident(s) with admissions agreement. It is alleged staff are not providing resident(s) with admissions agreement. Three (3) out of the three (3) staff interviewed deny this allegation. Four (4) out of the four (4) residents interviewed deny this allegation. LPA Ramirez reviewed R1’s admission agreement. R1 was admitted into the facility on 11/21/22. LPA Ramirez obtained a copy blank facility Admissions Agreement, Schedule B -Optional Fees, and Point Assessment of Resident. 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.

Staff not responding to resident(s) call button. It is alleged that staff are not responding to resident(s) call button. While touring facility on 8/31/23, at 10:36 am LPA Ramirez pressed Resident #4 (R4) bathroom call/assistance button. At 10:39 am, staff arrived to R4’s accommodation to assist R4. At 10:50 am, LPA Ramirez received permission from Resident#5 (R5) to press R5’s call pendant that was secured around R5’s neck. At 10:53 am, staff arrived near hallway on the 4^th floor, where R5 and LPA Ramirez were waiting. 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.

No discrepancies were cited during today’s visit. Exit interview was conducted with Administrator Taliaferro and a copy of this report was provided.

SUPERVISOR'S NAME: Tony Vasallo	TELEPHONE: (323) 981-3977
LICENSING EVALUATOR NAME: Kimberly Ramirez	TELEPHONE: (323) 981-3970
LICENSING EVALUATOR SIGNATURE:	DATE: 09/02/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/02/2023

LIC9099 (FAS) - (06/04)

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