198603416-6-23-2023-28-AS-RORN-CWHLSU-20231011090115

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198603416
Report Date: 05/18/2023
Date Signed: 06/23/2023 10:59:03 AM

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
05/08/2023 and conducted by Evaluator Alberto Lopez

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20230508091734

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: 131	DATE:	05/18/2023
		UNANNOUNCED	TIME BEGAN:	09:44 AM
MET WITH:	Kevin Taliaferro, Administrator `		TIME COMPLETED:	04:13 PM

ALLEGATION(S):

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Facility staff did not provide resident basic care and assistance at the facility.
Facility staff did not provide resident medication on a timely basis.
Facility staff did not provide resident water to be taken with their medication.

INVESTIGATION FINDINGS:

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****This amended report supersedes report dated 5/18/2023 and was amended to removed identifying information only, nothing else was changed and findings remain the same****

LPA Alberto Lopez made unannounced subsequent visit to investigate the above allegations:
The investigation consisted of Interviews with seven (7) staff (S1-S7), thirteen residents (R1-R13), reviewing and obtaining copies of staff roster, residents’ roster, R1 Physicians report, MAR, and other relevant medical information for R1

Allegation: Facility staff did not provide resident basic care and assistance at the facility. It is alleged that the facility failed to provide resident with basic care and assistance at the facility. Seven of seven staff interviewed denied the allegations. LPA interviewed 13 residents and 12 of 13 residents could not collaborate the allegations. Several residents stated they were very happy with the assistance they get, and several stated they require little to no assistance. (continued on 9099C)

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Lisa Hicks	TELEPHONE: (323) 981-3972
LICENSING EVALUATOR NAME: Alberto Lopez	TELEPHONE: 323-980-4926
LICENSING EVALUATOR SIGNATURE:	DATE: 05/18/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/18/2023

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 4

Control Number 28-AS-20230508091734

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: 05/18/2023

NARRATIVE

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Allegation: Facility staff did not provide resident medication on a timely basis. It is alleged that the resident’s medication due between 4:00 -4:30AM was not provided to resident on 05/06/2023 between that time frame. According to the MAR review it was dispensed on time. 7 of 7 staff denied the allegations. 12/13 residents could not collaborate the allegations. One resident stated that staff can be late maybe 5 to 10 minutes but overall, most residents stated they get their medication on time. S3 stated S3 went to resident’s room at around 4:30AM to dispense R1 medication and did not see resident in R1 room, S3 Stated S3 heard water running in the bathroom and assumed R1 was in bathroom so S3 left to attend another resident. S3 stated S3 returned shortly after to R1 room but R1 was not there at the time. Shortly after that S3 got a call from S4 stating fire department was at facility. R1 stated R1 went down to the lobby to find out about R1 medications around 4:30AM and found no one at the front desk and the phone was vibrating and vibrating. R1 then called 911. At approximately 5:25 – 5:30AM incident was resolved, and resident received her medication within time frame allowed due to one hour window allowed. According to statement from R1 and S3, they missed each other.

Allegation: Facility staff did not provide resident water to be taken with their medication. It is alleged that staff did not provide resident with water with her medication. 6/7 staff denied the allegations and stated that there is water in many areas of the facility. S3 stated that S3 did not have any water when she went from resident’s room down to lobby on 5/06/2023 and that S3 was asked by R1 for water and S3 stated S3 promptly went to the kitchen and grabbed an apple juice and provided it to client to take her medications. S4 collaborated this. 12 of 13 residents stated facility always has water available for them to take their medications.

Although the allegations 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 allegations are UNSUBSTANTIATED.

An exit interview was conducted with Administrator. A copy of this report was provided.

SUPERVISOR'S NAME: Lisa Hicks	TELEPHONE: (323) 981-3972
LICENSING EVALUATOR NAME: Alberto Lopez	TELEPHONE: 323-980-4926
LICENSING EVALUATOR SIGNATURE:	DATE: 05/18/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/18/2023

LIC9099 (FAS) - (06/04)

Page: 2 of 4

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
05/08/2023 and conducted by Evaluator Alberto Lopez

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20230508091734

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: 131	DATE:	05/18/2023
		UNANNOUNCED	TIME BEGAN:	09:44 AM
MET WITH:	Kevin Taliaferro, Administrator `		TIME COMPLETED:	04:13 PM

ALLEGATION(S):

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Facility did not have sufficient staff to meet the needs of the residents

INVESTIGATION FINDINGS:

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Allegation: Facility did not have sufficient staff to meet the needs of the residents. It is alleged that facility does not have enough properly trained staff to care and supervise the residents during the overnight shift 12:00AM – 8:30 AM. on 5/06/2023 Administrator stated they have 5 staff during the overnight shift 12:00AM – 8:30AM. Five of seven staff collaborated the allegations and stated they are short staff and overworked and must jog at times to meet their duties. 12 of 13 residents agreed that facility can use more staff. During the day of the incident, Fire department personnel arrived at the facility at 5:20AM and there was no staff to greet them or let them into facility. Fire department contacted R1 via phone and R1 made the trip down to allow the fire department access to the facility.
No staff was available at that time to allow the Fire Department Entry which poses a health and safety hazard for residents in care.

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 are being cited on the attached LIC 9099D.

Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Lisa Hicks	TELEPHONE: (323) 981-3972
LICENSING EVALUATOR NAME: Alberto Lopez	TELEPHONE: 323-980-4926
LICENSING EVALUATOR SIGNATURE:	DATE: 05/18/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/18/2023

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

Page: 3 of 4

Control Number 28-AS-20230508091734

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
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 05/18/2023

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type A 05/29/2023 Section Cited CCR 87415(3)	1 2 3 4 5 6 7	87415 (3) Night Supervision (3) In facilities caring for one hundred one (101) to two hundred (200) residents, one employee shall be on call, on the premises; one employee shall be on duty on the premises and awake; and one employee shall be on call and capable of responding within ten minutes. This requirement was not met as evidenced by:	1 2 3 4 5 6 7	POC Administrator stated he will hire additional staff and train all staff to respond to emergency personnel during the overnight shift.
	8 9 10 11 12 13 14	Emergency Fire personnel arrived at facility and could not access the facility because there was no one at the front desk to let them in and had to contact resident via phone to allow them entry. No staff was available at that time to allow the Fire Department Entry which poses a health and safety hazard for 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: Lisa Hicks	TELEPHONE: (323) 981-3972
LICENSING EVALUATOR NAME: Alberto Lopez	TELEPHONE: 323-980-4926
LICENSING EVALUATOR SIGNATURE:	DATE: 05/18/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/18/2023

LIC9099 (FAS) - (06/04)

Page: 4 of 4