197609014-7-24-2023-31-AS-MVAO-D42UEW-20240405153148

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197609014
Report Date: 07/24/2023
Date Signed: 07/24/2023 02:32:00 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
N LA & CEN COA AC/SC, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364

This is an official report of an unannounced visit/investigation of a complaint received in our office on
07/19/2023 and conducted by Evaluator Evelin Rios

PUBLIC

COMPLAINT CONTROL NUMBER: 31-AS-20230719104627

FACILITY NAME:	EL MOLINO MANOR		FACILITY NUMBER:	197609014
ADMINISTRATOR:	PASCASIO, GLORIA		FACILITY TYPE:	735
ADDRESS:	2544 N EL MOLINO AVENUE		TELEPHONE:	(626) 639-4270
CITY:	ALTADENA	STATE: CA	ZIP CODE:	91001
CAPACITY:	36	CENSUS: 30	DATE:	07/24/2023
		UNANNOUNCED	TIME BEGAN:	10:25 AM
MET WITH:	Zonel Pascasio (Administrator)		TIME COMPLETED:	02:45 PM

ALLEGATION(S):

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Staff does not ensure resident seeks dental assistance.
Staff does not follow up on resident's medical needs.

INVESTIGATION FINDINGS:

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On 07/24/2023 Licensing Program Analysts (LPAs) Evelin Rios and Christopher Alemoh conducted an unannounced complaint visit for the above allegations. LPAs arrived at the facility at 10:25 a.m. and were greeted by staff #1(S1). LPAs met with Licensee Zeph Pascasio and explained the reason for the visit. Administrator Zonel Pascasio met LPAs shortly after and entrance interview conducted.

At 10:30 a.m. LPAs, licensee and administrator conducted a physical plant tour to ensure the health and safety of the residents in care. No issues or concerns were observed. From 10:31 a.m. to 11:30 a.m. LPAs interviewed at random four (4) out of thirty (30) residents. From 11:31 a.m. to 1:30 p.m. LPAs conducted additional interviews with licensee, administrator, resident #1 (R1’s) family members and R1’s conservator. LPAs reviewed resident records, facility Program submitted to Community Care Licensing (CCL) and obtained documents relevant to this investigation.
(LIC9099 Continued on next page)

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Eva Miller
LICENSING EVALUATOR NAME: Evelin Rios
LICENSING EVALUATOR SIGNATURE:	DATE: 07/24/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/24/2023

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 31-AS-20230719104627

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
N LA & CEN COA AC/SC, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364

FACILITY NAME: EL MOLINO MANOR	FACILITY NUMBER: 197609014
	VISIT DATE: 07/24/2023

NARRATIVE

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Allegation #1: Staff does not ensure resident seeks dental assistance.
It is alleged (R1) needs a dental procedure, but facility has not provided assistance to obtain appointment. Interviews with licensee and administrator revealed R1 had a referral made and approved for a dentist procedure while at their previous facility. R1's conservator corroborated an approval has been made and required documentation was sent over to the appropriate dentist on June 29, 2023. Conservator states a follow-up will be made by them to check on status of future appointment for procedure. Licensee is following up on a dentist that will make regular dental check ups at the facility. Interviews with four (4) out of four (4) residents interviewed today reported no issues with obtaining or asking for dental appointments. Furthermore, the facility program states, "Medical and dental appointments will be scheduled. A once every six month dental cleaning will be scheduled for each Client" , licensee states appointments with dentist have been made for residents, however there is a long wait for appointments due to in-network dentist being backed up. Based on the information provided through interview and records review this allegation is UNSUBSTANTIATED at this time.

Allegation #2: Staff does not follow up on resident's medical needs.
It is alleged R1 is required a specific diet due to their medical condition and facility is not following up with R1's physician. Interview, with licensee revealed the facility offerers fresh fruit with meals and has directed staff to ensure R1 has fruit with meals and offer a different meal when R1 refuses to eat the first option. According to licensee R1 has refused meals and will often go out and purchase fast food. According to R1's family member R1 recently has gotten prescribed proper medication to manage R1's medical conduction but facility has made fruit optional instead of provided it with meals. According to administrator the facility makes snacks available to residents by placing them on a counter by the kitchen. Furthermore, licensee states they follow-up with R1 and R1 has not mentioned any concerns about medical needs. Based on interviews and record review, although the allegation may have happened or is valid, there is insufficient evidence to prove the alleged violation did or did not occur. Therefore, the allegation is deemed UNSUBSTANTIATED at this time.

Exit interview conducted. Appeal rights discussed. Copy of report provided.

SUPERVISORS NAME: Eva Miller
LICENSING EVALUATOR NAME: Evelin Rios
LICENSING EVALUATOR SIGNATURE:	DATE: 07/24/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/24/2023

LIC9099 (FAS) - (06/04)

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