198603416-2-26-2024-28-AS-WSHO-D2WMZA-20240229090245

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198603416
Report Date: 02/26/2024
Date Signed: 02/26/2024 12:45:24 PM

Unsubstantiated

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
02/20/2024 and conducted by Evaluator Nune Margaryan

COMPLAINT CONTROL NUMBER: 28-AS-20240220084940

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: 148	DATE:	02/26/2024
		UNANNOUNCED	TIME BEGAN:	09:00 AM
MET WITH:	Kevin Taliaferro - Executive Director		TIME COMPLETED:	12:45 PM

ALLEGATION(S):

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Staff mismanaged a resident's medication record.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Nune Margaryan conducted an unannounced complaint investigation visit regarding the above allegations. LPA Margaryan met with Executive Director Kevin Taliaferro and explained the reason for the visit.

The investigation consisted of the following: LPA obtained copies of Staff & Client Rosters, Official Transcripts and Course Completion History for Med Techs, copy of Med Staff Schedule. LPA also interviewed Staff #1 - Staff #5 (S #1-S #5). S# 4 was interviewed over the phone. Medication Administration Records (electronic MAR and paper MAR) were reviewed.

Continue 9099C

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Wei Siew Ho	TELEPHONE: (323) 981-3378
LICENSING EVALUATOR NAME: Nune Margaryan	TELEPHONE: 323-981-3378
LICENSING EVALUATOR SIGNATURE:	DATE: 02/26/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/26/2024

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-20240220084940

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: MORNINGSTAR OF PASADENA	FACILITY NUMBER: 198603416
	VISIT DATE: 02/26/2024

NARRATIVE

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The investigation revealed the following: in regard to the allegation " Staff mismanaged a resident's medication record", it is alleged that someone signed initials for med tech that wasn't there, and director of the department is not doing anything about it.

Staff interviewed deny the allegation. Records reviewed did not support the allegation. There were no errors observed during the Medication Administration Records review. LPA didn't find any discrepancy and could not locate any documents that suggest facility staff sign initials for another med tech who wasn't there. Staff interviewed deny the allegation. They stated that everyone has their own passwords to log in in the system / MAR, and they can’t sign for another Med Tech, and someone can't sing for them. There were no witnesses to 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.

Exit interview held and a copy of the report was provided to Executive Director Kevin Taliaferro.

SUPERVISOR'S NAME: Wei Siew Ho	TELEPHONE: (323) 981-3378
LICENSING EVALUATOR NAME: Nune Margaryan	TELEPHONE: 323-981-3378
LICENSING EVALUATOR SIGNATURE:	DATE: 02/26/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/26/2024

LIC9099 (FAS) - (06/04)

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