198603416-9-25-2023-28-AS-TVAO-CWKUFB-20231013153226

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198603416
Report Date: 09/25/2023
Date Signed: 09/25/2023 04:38:55 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
09/20/2023 and conducted by Evaluator Cynthia D Chan

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20230920112244

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:	09/25/2023
		UNANNOUNCED	TIME BEGAN:	11:17 AM
MET WITH:	Kevin Taliaferro, Administrator		TIME COMPLETED:	04:30 PM

ALLEGATION(S):

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Staff did not prevent resident from assaulting another resident in care.
Staff handled resident in a rough manner.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Cynthia Chan conducted a complaint investigation for the above allegations. LPA arrived unannounced and met with Rhonda Guzman, the Wellness Director. The reason for the visit was explained.

LPA obtained copies of the staff roster, resident roster, and staff training logs. LPA also toured the memory care unit and reviewed file for Resident #1. Interviews were held with Staff, Residents, and a family member.

Allegation - Staff did not prevent resident from assaulting another resident in care. It is alleged that staff saw resident (R1) walk over to another resident (R2) and punched him/her on the back, but staff did not prevent it from happening. The incident occurred in the memory care unit.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Tony Vasallo	TELEPHONE: (323) 981-3977
LICENSING EVALUATOR NAME: Cynthia D Chan	TELEPHONE: (323) 981-3370
LICENSING EVALUATOR SIGNATURE:	DATE: 09/25/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/25/2023

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-20230920112244

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: 09/25/2023

NARRATIVE

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LPA interviewed the administrator and 7 Staff. Staff stated they will intervene right away if they see a resident assault or try to assault another resident. They have training on dementia care and will monitor residents in memory care unit closely. They will redirect a resident as much as possible versus using any kind of restraint. For incident involving R1 and R2, staff who witnessed the incident stated that both staff tried redirecting R1 as they saw resident yelling and hitting R2. They later held R1’s hands gently to prevent resident from hitting R2 again. Staff stated R1 moved in several weeks ago and have been monitoring resident more often due to some challenging behaviors. LPA interviewed 4 residents and a family member. They stated staff are attentive and caring. 4 out of 5 individuals indicated staff supervise residents and will quickly intervene if a situation arise to protect the health and safety of residents.

Allegation - Staff handled resident in a rough manner. It is alleged that 2 staff each held Resident #1’s forearm and lower part of the bicep for control while walking resident to the room. Per the administrator, they will normally redirect to calm down the resident. However, if the resident is aggressive/violent and endangering other residents, they will hold down the forearm or hands of the resident but still going along with their movement. They do not use force as they are holding their arms/hands. Staff, who dealt with the incident involving Resident #1 (R1), stated they held the arms of R1 as they attempt to calm resident down while escorting to the room but did not use force. There were no reports of any marks or bruises to the resident, as noted by the local police officer and staff. Staff interviewed indicated they have not seen other staff handling residents in a rough manner. Staff are careful with residents because they know how fragile their skins are and do not want to cause any tears or bruises. LPA interviewed 4 residents and a family member. Residents stated that staff do not handle them or others in a rough manner. The family member interviewed have not seen staff being rough with residents and only had positive feedback.

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.

An exit interview was conducted with the administrator. A copy of this report along with the appeal rights were provided.

SUPERVISOR'S NAME: Tony Vasallo	TELEPHONE: (323) 981-3977
LICENSING EVALUATOR NAME: Cynthia D Chan	TELEPHONE: (323) 981-3370
LICENSING EVALUATOR SIGNATURE:	DATE: 09/25/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/25/2023

LIC9099 (FAS) - (06/04)

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