Facility Evaluation Report

Pasadena Mansion, Pasadena09/28/2022Licence 197605216

Capacity6
Census5
Date signed09/28/2022 02:53:26 PM
The inspector’s account

Licensing Program Analyst(s)(LPA) Mary Flores conducted an unannounced plan of correction(POC) visit to follow up on deficiencies given on 9/21/22. LPA Flores met with Larry Ho Caregiver an explained the reason for the visit.

On 9/21/22 LPA Flores conducted an annual inspection visit and cited the following deficiencies:

Type A Section 87309(a) Storage Space. LPA Flores observed cleaning, disinfecting supplies, and sharps were unlocked during the visit. On 9/28/22 LPA Flores observed all cleaning products have been removed and are under lock in garage. Deficiency cleared on 9/28/22.

Type Section 87465(h)(2) Incidental Medical and Dental Care Services. LPA Flores observed medication cabinet, and resident's medication observed in refrigerator were not lock. On 9/28/22 LPA Flores observed medication cabinet not locked, a medication box with lock was observed in the refrigerator. *Civil Penalties have been assets for Failure to Correct on LIC 421FC for a total of $600.*

Type A Section 87204(b) Limitations - Capacity and Ambulatory Status. LPA Flores observed resident #4 (R4) status is non-ambulatory and resides in second floor. On 9/28/22 LPA Flores observed R4 continues to reside in the second floor. *Civil Penalties have been assets for Failure to Correct on LIC 421FC for a total of $600.*

Exit interview was conducted with Larry Ho Caregiver and a copy of this report, LIC 421FC, and appeal rights were provided.

Source: California Department of Social Services, Community Care Licensing. Methodology · Report a correction