Inspection visit

Follow-up on correctionsMay 10, 2024

PASADENA VILLA SENIOR LIVINGLicense 1986032863 citations on this visit

3 citations recorded

Inspector’s narrative

What the inspector wrote

Licensing Program Analyst (LPA) Tena Herrera conducted an unannounced Case Management Visit to address additional information obtained during Complaint Control #28-AS-20231229081912 which was investigated by the Department’s Investigations Bureau Branch. During interviews conducted and record review, Investigator Padilla was made aware of the following: · There were inconsistent and false statements from both S1 and S2 about the accounts of R1's injuries and who arranged medical transportation for R1. On the Unusual Incident/Injury Report (SIR) that was submitted to CCL, it states that staff observed R1 with their right arm bleeding, and S3 arranged transportation, however, records obtained revealed that R1 called 911 for help themselves to be transported to hospital for further treatment. Facility should have submitted an addendum to their SIR to provide this updated information. · On an unrelated incident, Investigator Padilla was informed during interviews that R2 had been without a room for 2-3 days because their roommate became aggressive with R1 and kicked R1 out of the room. This was confirmed by S4 who found R1 sleeping on the floor. During interview with R2 Investigator confirmed this information and observed R2 with a few bags in the facility hallway. S1 also confirmed that the two residents were having issues, and S1 was working on getting R2 a new room. · There was an incident that occurred where S1 was involved in a physical altercation with R1's family member and S1 sustained injuries to their eye during the altercation, an incident report was not filed for this incident and police was called. Based on investigation conducted by IB Investigator, along with interviews and statements with Staff and Residents, the following deficiencies listed above are being cited on the attached LIC 809-D. LPA did not observe any health and safety concerns during today’s visit. Exit interview was conducted, a hard copy of this report and appeal rights were provided to Maria Razo.

Citations

3 citations recorded^*CCLD

What does Type A vs Type B mean?

Type A. Serious citation. Imminent or substantial risk to children. The regulator requires corrective action immediately and may impose a civil penalty.

Type B. Lower-severity citation. Corrective action required, no imminent risk. The regulator monitors compliance on the next visit.

87207Type B
No licensee, officer or employee of a licensee shall make or disseminate any false or misleading statement regarding the facility or any of the services provided by the facility.This requirment is not met evidence by: Based on IB's investigation it was determined that there were inconsistent/false statements from staff about R1's injuries and who arranged medical transportation for R1, the SIR states staff arranged transportation, however, records reveal that R1 911 for help and to be transported to hospital for further treatment.
87211(a)(1)Type B
87211 Reporting Requirements (a) Each licensee shall furnish to the licensing agency such reports as the Department may require, including, but not limited to, the following: (1)A written report shall be submitted to the licensing agency and to the person responsible for the resident within seven days of the occurrence of any of the events specified in (A) through (D) below. This report shall include the resident's name, age, sex and date of admission; date and nature of event; attending physician's name, findings, and treatment, if any; and disposition of the case. This requirment is not met evidence by:IB discovered there was an incident that occurred where S1 was involved in a physical altercation with R1's family member and sustained injuries to their eye during the altercation, an incident report was not filed for this incident and police was called.
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87468.1(a)(3)Type B
87468.1 Personal Rights of Residents in All Facilities (a) Residents in all residential care facilities for the elderly shall have all of the following personal rights: (3) To be free from punishment, humiliation, intimidation, abuse, or other actions of a punitive nature, such as withholding residents’ money or interfering with daily living functions such as eating, sleeping, or elimination. This requirment is not met evidence by:During IB interview with R2 it was stated that R2 had been without a room for 2-3 days. This was confirmed by S4 who found R1 sleeping on the floor and S1 also confirmed that the two residents were having issues, and S1 was working on getting R2 a new room. IB also observed R2 with a few bags in the facility hallway.

FAQ · About this visit

Common questions about this visit

What happened during the May 10, 2024 inspection of PASADENA VILLA SENIOR LIVING?

This was a other inspection of PASADENA VILLA SENIOR LIVING on May 10, 2024. 3 citations were issued: 3 Type B.

Were any citations issued to PASADENA VILLA SENIOR LIVING on May 10, 2024?

Yes, 3 citations were issued (0 Type A, 3 Type B). The first citation was for: "No licensee, officer or employee of a licensee shall make or disseminate any false or misleading statement regarding the..."

What type of inspection was this?

This was a other inspection. other inspections are conducted by CCLD as part of their licensing oversight.

SourceView on CCLD View original report

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Data from CCLD public records. Last updated May 25, 2026. If you believe any information is inaccurate, report it here.

Follow-up on corrections·May 10, 2024