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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198603416
Report Date: 01/30/2025
Date Signed: 02/05/2025 09:05:00 AM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK ASC, 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
12/16/2024 and conducted by Evaluator Sanjay Vaid
PUBLIC
COMPLAINT CONTROL NUMBER: 28-AS-20241216131145
FACILITY NAME:MORNINGSTAR OF PASADENAFACILITY NUMBER:
198603416
ADMINISTRATOR:TALIAFERRO, KEVINFACILITY TYPE:
740
ADDRESS:951 S. FAIR OAKS AVENUETELEPHONE:
(626) 204-1700
CITY:PASADENASTATE: CAZIP CODE:
91105
CAPACITY:310CENSUS: 147DATE:
01/30/2025
UNANNOUNCEDTIME BEGAN:
11:46 AM
MET WITH:Kevin Taliaferro, AdministratorTIME COMPLETED:
03:30 PM
ALLEGATION(S):
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Unqualified staff are administering injections to residents.
Unqualified staff are taking residents vital signs.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) S. Vaid conducted a subsequent complaint visit regarding the allegations listed above to deliver finding to the complaint allegations.

On 12/17/2024, the investigation consisted of the following: LPA obtained copies of Staff & Client Rosters, Official Transcripts and Course Completion History (7) Med Techs, copy of Staff by department, name list of resident care of level. Name list of residents who are prescribed injections. Collected face sheet, physicians report, eMARs list, and residents' Needs/Services and care plans, four (4) residents. Staff file for LVN nurses. LPA interviewed 6 staff and 4 residents.

On today’s date 01/30/2025 visit LPA Vaid interviewed 5 residents.
Regarding the allegation: Unqualified staff are administering injections to residents. It is alleged that management staff is making the med-techs administer injections to residents when the med-tech are clearly not trained on how to administer injection.
Continued on 9099C.......
Unsubstantiated
Estimated Days of Completion:
NAME OF LICENSING PROGRAM MANAGER: Fernando Fierros
NAME OF LICENSING PROGRAM ANALYST: Sanjay Vaid
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 01/30/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/30/2025
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 2
Control Number 28-AS-20241216131145
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK ASC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754
FACILITY NAME: MORNINGSTAR OF PASADENA
FACILITY NUMBER: 198603416
VISIT DATE: 01/30/2025
NARRATIVE
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Six (6) out of six (6) staff interviewed deny this allegation. Nine (9) out of nine (9) residents interviewed could not corroborate this allegation. The facility is an assisted living facility, not a medical facility. The residents R1-R4, who receive injections for their health condition say they are assisted by the med-techs when administering self-injection of the medication. The med-techs prepare and hands the inject to the resident to self-inject. A times when residents are feeling weak or are unsure of the injection protocols due to forgetfulness or other issues. The med-tech will use hand-over-hand method of delivering the medication to the resident. The resident is in full control of the syringe as it penetrates the skin and medication is then injected into the body. LPA observed med-tech prepare the injection syringe by turning the insulin pen to fill dosage into the vial, then discuss with resident of the medication to be injected. The med-tech then hands the insulin pen for the resident to self-inject. Although the allegation may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations occurred, therefore the allegations is unsubstantiated.
Regarding the allegation: Unqualified staff are taking residents vital signs. It is alleged that unqualified staff are taking vital signs of the residents when the staff are not trained to do so. Six (6) out of six (6) staff deny the allegation. Nine (9) out of nine (9) residents could not corroborate this allegation. Vital signs are taken for residents who show trends of abnormal readings via electronic medical recording device by the licensed medical professional. LVN’s are on call and reached when readings shown on electronic instrument reading is systolic below 90 and diastolic is less than 60. When residents pressure reading is abnormal from the reading of the medical device the LVN will then conduct a manual check of the residents’ pressures, the LVN will then notify the residents physician and communicate the readings. The doctor will give instruction to LVN on procedures regarding resident’s health and level of care to be provided. The protocols for checking the vitals for the residents, check the physician orders if vitals are needed recording (not all residents are having physician orders for vitals checked daily). Med-techs dispense medication to same residents for one week at a time becoming familiarized with residents’ medications, and any visible changes to resident health to report back to the LVN for further assistance. Licensed Vocation Nurses using the electronic medical device for vitals, records and forwards to residents’ physician monitoring their patients daily/weekly vital trends due to changes in medication or other medical issues determined by the doctor. Only licensed medical professionals are recording the medical device readings and reporting information to the residents’ physicians. Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations occurred, therefore the allegation is unsubstantiated.

Exit interview conducted with Kevin Taliaferro, administrator. A copy of this report was provided.
NAME OF LICENSING PROGRAM MANAGER: Fernando Fierros
NAME OF LICENSING PROGRAM ANALYST: Sanjay Vaid
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 01/30/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/30/2025
LIC9099 (FAS) - (06/04)
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