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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198603416
Report Date: 03/28/2025
Date Signed: 03/28/2025 04:19:51 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
08/11/2024 and conducted by Evaluator Nune Margaryan
COMPLAINT CONTROL NUMBER: 28-AS-20240811211753
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: 146DATE:
03/28/2025
UNANNOUNCEDTIME BEGAN:
11:30 AM
MET WITH:Kevin Taliaferro - Executive DirectorTIME COMPLETED:
04:20 PM
ALLEGATION(S):
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Staff neglect resulted in a resident sustaining a death.
Staff mishandled the residents medications.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Nune Margaryan conducted an unannounced subsequent complaint investigation regarding the above allegations. LPA met with Kevin Taliaferro, Executive Director and discussed the purpose of the visit.

The investigation consisted of the following: LPA requested copies of Residents & Staff Roster and conducted a tour of facility. LPA reviewed and received copies from Resident #1's (R1) file and Death report. During today’s visit LPA interviewed Executive Director, Wellness Director, Staff #1 – Staff #4 (S1 – S4), Residents #2 – Residents#11 (R2 – R11). S4 and Resident #1’s (R1) family member (FM) were interviewed over the phone.

Continue 9099C

Unsubstantiated
Estimated Days of Completion:
NAME OF LICENSING PROGRAM MANAGER: Wei Siew Ho
NAME OF LICENSING PROGRAM ANALYST: Nune Margaryan
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 03/28/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/28/2025
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 3
Control Number 28-AS-20240811211753
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: 03/28/2025
NARRATIVE
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Regarding allegation: Staff neglect resulted in a resident sustaining a death. It was alleged that there was one occasion where a resident had passed away in his room and no one knew or found him until 3 days later when resident’s son called for a welfare check. Interviewed Executive Director, Wellness Director and (4) of (4) staff denied the allegation. (10) of (10) residents interviewed could not corroborate the allegation. Interviewed FM stated that they spoke with R1 every day. FM stated that R1 never expressed dissatisfaction about facility. R1 always said that he/she felt very comfortable at the facility and facility staff very attentive and caring towards him and other residents. Facility staff always kept FM informed about R1. FM stated that Facility staff were very caring and R1 died a natural death, and FM has no concerns about that. Staff informed FM of the death on the same day R1 died and staff did everything right. Executive Director stated that he was at the facility on 06/08/24 from 5:00 am and stayed to about 9:00 am. Executive Director saw R1 at the Bistro around 8:00 am having breakfast. They chatted briefly, which was normal for them. Later that evening R1 had passed and by the protocol, staff called 911 and family members were notified. Wellness Director stated that facility staff monitor all resident's closely to assess and determine if there is an immediate concern that requires immediate attention. There has never been a case where a resident passed away in his room and staff were not aware of it. Interviewed S1, S2, S3, S4 stated that staff frequently check on residents and there was no incident that resident passed away at the facility and staff didn’t know about that until 3 days.

Continue 9099C

NAME OF LICENSING PROGRAM MANAGER: Wei Siew Ho
NAME OF LICENSING PROGRAM ANALYST: Nune Margaryan
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 03/28/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/28/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 28-AS-20240811211753
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: 03/28/2025
NARRATIVE
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Staff mishandled the residents medications. It was alleged that residents are complaining that they received wrong medication and Wellness nurse take residents medication and take home. Interviewed Executive Director, Wellness Director and (4) of (4) staff denied the allegation. They stated that staff administrated medications by physician's order and in a timely manner and no one take resident’s medications home. They stated that the medications are kept locked at all times. (10) of (10) residents interviewed could not corroborate the allegation. Interviewed Executive director and Wellness Director stated that they didn’t hear any complaints about residents received wrong medication or staff takes residents medications home. Interviewed S4 stated they never took residents medication home. S1, S2, S3 and S4 stated that all medications are administrated as prescribed and are noted electronically through an "Alis" program and all residents’ medications are registered under the "Alis" program. Interviewed staff demonstrated to LPA how is worked "Alis" program. LPA observed that residents medications are registered under the "Alis" program. LPA didn’t find any discrepancy. LPA toured the medication room and confirmed medications are kept locked. Interviewed staff stated if there are discontinued medications or medications for the residents who moved / passed away from the facility and didn't take medications with them, will be destroyed in a proper way. Medications are destroyed by assigned staff and facility keeps record of destroyed medications (documents were provided). Residents interviewed stated that staff administrated medication correctly and they don't have any concerns regarding their medications. The information gathered does not corroborate the allegation noted above.

Based on the file/record reviews, observations and interviews conducted with staff and client there was not enough supportive evidence to concur with the reported allegations. 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 allegations are Unsubstantiated.



Exit interview was conducted and the copy of this report was provided to Executive Director.
NAME OF LICENSING PROGRAM MANAGER: Wei Siew Ho
NAME OF LICENSING PROGRAM ANALYST: Nune Margaryan
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 03/28/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/28/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 3