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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198603286
Report Date: 04/11/2025
Date Signed: 04/11/2025 05:35:10 PM

Substantiated


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
04/08/2025 and conducted by Evaluator Kimberly Ramirez
PUBLIC
COMPLAINT CONTROL NUMBER: 28-AS-20250408150001
FACILITY NAME:PASADENA VILLA SENIOR LIVINGFACILITY NUMBER:
198603286
ADMINISTRATOR:MURPHY, MICHAELFACILITY TYPE:
740
ADDRESS:1811 N. RAYMOND AVETELEPHONE:
(626) 791-6232
CITY:PASADENASTATE: CAZIP CODE:
91103
CAPACITY:97CENSUS: 59DATE:
04/11/2025
UNANNOUNCEDTIME BEGAN:
09:20 AM
MET WITH:Administartor Alex Solorio TIME COMPLETED:
02:30 PM
ALLEGATION(S):
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Staff did not safeguard residents personal belongings.
Staff did not prevent residents from entering the facility in unsafe conditions
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Kimberly Ramirez and LPA Blanca Gonzalez conducted an unannounced initial complaint investigation visit on 04/11/2025 regarding the above allegations. During today’s visit, LPAs were greeted by Corporate Maintenance Director- Marlon Mezquita and explained the purpose of the visit. Administrator Alexander Solorio arrived shortly after.

The investigation consisted of the following: LPA Ramirez conducted Staff#1 - 3 interviews (S1-S3), Attempted Interview of Staff #4 (S4), Resident# 1- 2 Interviews (R1-R2), Witness#1 Interview (W1), copies of R1 & R2 recent physician’s report (LIC 602), and physical plant tour.


SEE 9099-C
Substantiated
Estimated Days of Completion:
NAME OF LICENSING PROGRAM MANAGER: Tony Vasallo
NAME OF LICENSING PROGRAM ANALYST: Kimberly Ramirez
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 04/11/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/11/2025
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 5
Control Number 28-AS-20250408150001
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: PASADENA VILLA SENIOR LIVING
FACILITY NUMBER: 198603286
VISIT DATE: 04/11/2025
NARRATIVE
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The investigation revealed the following: regarding the allegation(s): Staff did not safeguard residents’ personal belongings- It is alleged staff are not safeguarding residents’ belongings while the facility is under renovation and repair due to the 2025 Eaton wildfires. Two (2) out of the two (2) residents interviewed corroborated this allegation. Interview of W1 corroborated this allegation. Interview Administrator Solorio revealed he instructed the renovation crew to cover all residents’ belongings with plastic wrap and indicate rooms numbers on items so residents can find their belongings easier. LPAs toured the facility in 4/11/202 at 9:04am. LPAs observed the facility to be under renovation. LPAs observed some personal items in such as clothing, blankets, shoes, large and small flat screen TVs, dressers, hygiene products and other personal items, stored in hallways, without plastic wrap, collecting dust and debris from the renovations being conducted. Resident interviews revealed resident’s items are scattered throughout the facility and staff is allowing all belongings to become dusty and several personal items have not been located due to them being scattered throughout the facility. Based on interviews conducted, the preponderance of evidence standard has been met, therefore the above allegation is found to be Substantiated.

Staff did not prevent residents from entering the facility in unsafe conditions- It is alleged staff did not prevent R1 & R2 from entering the facility in unsafe conditions. Three (3) out of the three (3) staff interviewed denied this allegation. Interview of W1 corroborated this allegation. Interview with W1 revealed on 4/7/2025, W1 arrived at the facility at 10:04 am and found R1 & R2 inside the facility. W1 revealed R1 & R2 advised W1 they drove to the facility together to look for their items. W1 revealed they did not observe facility staff supervising R1 & R2 while they were in the facility and only the renovations crew were present. W1 revealed it was unsafe for residents to be at the facility without supervision due to the renovations supplies and equipment being accessible to residents. Two (2) out of the two (2) residents corroborated they were present at the facility on 4/7/25. R1 & R2 revealed in past staff would meet them at the facility and supervise them while they searched for personal items. During facility tour, LPAs observed construction equipment such as paint cans, ladders, sanding equipment, and cleaning supplies scattered around the hallways. According to Administrator Solorio, no residents should be at the facility during renovations unless staff is there to supervise them. Based on interviews conducted, the preponderance of evidence standard has been met, therefore the above allegation is found to be Substantiated.



Two (2) deficiencies were cited for this complaint investigation. Exit interview was conducted. A copy of this report, 9099-D, and appeals rights was provided via email.
NAME OF LICENSING PROGRAM MANAGER: Tony Vasallo
NAME OF LICENSING PROGRAM ANALYST: Kimberly Ramirez
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 04/11/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/11/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 5
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
04/08/2025 and conducted by Evaluator Kimberly Ramirez
PUBLIC
COMPLAINT CONTROL NUMBER: 28-AS-20250408150001

FACILITY NAME:PASADENA VILLA SENIOR LIVINGFACILITY NUMBER:
198603286
ADMINISTRATOR:MURPHY, MICHAELFACILITY TYPE:
740
ADDRESS:1811 N. RAYMOND AVETELEPHONE:
(626) 791-6232
CITY:PASADENASTATE: CAZIP CODE:
91103
CAPACITY:97CENSUS: 59DATE:
04/11/2025
UNANNOUNCEDTIME BEGAN:
09:20 AM
MET WITH:Maintenance Director- Marlon MezquitaTIME COMPLETED:
02:30 PM
ALLEGATION(S):
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Staff did not notify licensing of renovation repairs to the facility.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Kimberly Ramirez and LPA Blanca Gonzalez conducted an unannounced initial complaint investigation visit on 04/11/2025 regarding the above allegations. During today’s visit, LPAs were greeted by Corporate Maintenance Director- Marlon Mezquita and explained the purpose of the visit. Administrator Alexander Solorio arrived shortly after.

The investigation consisted of the following: LPA Ramirez conducted Staff#1 - 3 interviews (S1-S3), Attempted Interview of Staff #4 (S4), Resident# 1- 2 Interviews (R1-R2), Witness#1 Interview (W1), copies of R1 & R2 recent physician’s report (LIC 602), and physical plant tour.

SEE 9099-C
Unsubstantiated
Estimated Days of Completion:
NAME OF LICENSING PROGRAM MANAGER: Tony Vasallo
NAME OF LICENSING PROGRAM ANALYST: Kimberly Ramirez
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 04/11/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/11/2025
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 5
Control Number 28-AS-20250408150001
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: PASADENA VILLA SENIOR LIVING
FACILITY NUMBER: 198603286
VISIT DATE: 04/11/2025
NARRATIVE
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Staff did not notify licensing of renovation repairs to the facility- It is alleged the licensee did not notify this licensing agency that the facility would be conducting renovation repairs. Three (3) out of the three (3) staff interviewed denied this allegation. The facility was issued a mandatory evacuation order on 1/8/25 due to the 2025 Eaton wildfires. Although the facility did not experience fire damage, the facility landscaping needed to be repaired, and an outdoor fence had fallen and damaged the HVAC. Since 1/08/2025, facility staff have been in regular communication with Community Care Licensing (CCL) regarding repopulation and renovations and repairs. 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.

No violations were cited for this allegation. Exit interview was conducted. A copy of this report was provided via email due to printer problems.

NAME OF LICENSING PROGRAM MANAGER: Tony Vasallo
NAME OF LICENSING PROGRAM ANALYST: Kimberly Ramirez
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 04/11/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/11/2025
LIC9099 (FAS) - (06/04)
Page: 4 of 5
Control Number 28-AS-20250408150001
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: PASADENA VILLA SENIOR LIVING
FACILITY NUMBER: 198603286
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/11/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Deficiency Dismissed
Type B
04/18/2025
Section Cited
CCR
87411(a)
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Facility personnel shall at all times be sufficient in numbers, and competent to provide the services necessary to meet resident needs. In facilities licensed for sixteen or more, sufficient support staff shall be employed to ensure provision of personal assistance and care as required
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require any facility to provide additional staff whenever it determines through documentation that the needs of the particular residents, the extent of services provided, or the physical arrangements of the facility require such additional staff for the provision of adequate services.
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in Section 87608, Postural Supports. Additional staff shall be employed as necessary to perform office work, cooking, house cleaning, laundering, and maintenance of buildings, equipment and grounds. The licensing agency may
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The licensee did not met this requirement as evidenced by: the licensee did not ensure the facility was inaccessible to residents while renovations are taking place.Administrator Solorio agreed to certify plan to address how the facility will address residents gaining entry into the facility while renovations are being conducted.
Deficiency Dismissed
Type B
04/18/2025
Section Cited
CCR
87217(b)
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Every facility shall take appropriate measures to safeguard residents' cash resources, personal property and valuables which have been entrusted to the licensee or facility staff.
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Administrator Solorio agreed to certify plan to address how the facility plans to properly safeguard residents personal belongings during renovations and repairs.
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The licensee shall give the residents receipts for all such articles or cash resources.
This requirement was not met as evidenced by: Staff did not properly cover residents personal belongings during renovations and repairs.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
NAME OF LICENSING PROGRAM MANAGER: Tony Vasallo
NAME OF LICENSING PROGRAM ANALYST: Kimberly Ramirez
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 04/11/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/11/2025
LIC9099 (FAS) - (06/04)
Page: 5 of 5