Pasa Alta West

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Daniel Konishi conducted an unannounced Required-1 year visit. Upon arrival, no one answered the door and LPA called the facility number. At 1:55pm, Brisia Rojas, DSP arrived and explained the purpose of the visit. At 2:00pm, Staci Mitchell, Administrator arrived and assisted LPA with the inspection. The facility is licensed to serve six (6) ambulatory adults 60 years of age or older with developmental disabilities. The facility is vendorized by the Frank D. Lanterman Regional Center. LPA inspected the facility using the Compliance and Regulatory Enforcement (CARE) tool and observed the following: Infection Control: Staff are adhering to infection control requirements. The staff use disposable gloves to clean and disinfect the high touched surfaces in the common areas. Facility has sufficient PPE supplies and has an Infection Control Plan maintained at the facility. Physical Plant/Environment Safety: The facility is a single-story home which consists of: living room, dining area, kitchen, four (4) bedrooms (3 residents and 1 staff), two (2) bathrooms, one (1) staff bathroom, and laundry area. Resident bedrooms were inspected and closet/drawer space to accommodate each resident comfortably was available. LPA inspected residents’ rooms and each resident bedroom has the required furniture such as bed frames, dressers, nightstand, lamps, and chairs. Bedrooms also have sufficient closet space. Extra linens and towels are kept in a hallway closet. The bathrooms are clean and operational. The hot water temperature was tested throughout the facility. Hot water temperature were measured between 105.2 degrees F to 106.1 degrees F which are within the required 105 - 120 degrees F Smoke detectors and carbon monoxide detectors were tested and operable. Two (2) fire extinguishers were fully charged and last serviced on 05/02/2025. Physical Plant/Environment Safety [Cont.]: The front yard and backyard are free of debris/hazards and the outdoor and passageways are free of obstruction. A shaded area with chairs is provided in the back yard. There is no evidence of bodies of water (pool). Sharps are kept in a locked cabinet and are inaccessible to residents. All storage areas for cleaning solutions, toxins, and hazardous items are kept in a locked cabinet and are inaccessible to residents. Operational Requirements: The facility has an approved fire clearance. Valid Infection Control Plan in place. Valid liability insurance and valid Surety Bond is in place. Last fire drill was conducted on 11/13/2025 and disaster drill was conducted on 12/20/2025. Staffing: A total of ten (10) staff members including the Administrator and Licensee provide care and supervision to the residents. Staff employed are over the age of 18 and have criminal background clearance, fingerprint cleared, have training and associated to the facility. Personnel Records-Training: LPA reviewed four (4) staff files which include Personnel Record, Health Screening, TB Clearance, Employee Rights, First Aid/CPR/AED training, and Staff Training. However, the Administrator has a valid Adult Residential Facility (ARF) Administrator Certificate that expires on 01/20/2026 in file but does not have a valid Residential Care Facility for the Elderly (RCFE) Administrator certificate in file. Residents Rights-Information: Residents are provided with telephone and internet at the facility. The facility has the following posters posted: Residents Rights, Complaint Poster, and Ombudsman. Planned Activities: Facility provides scheduled activities and have a variety of activities to choose from within the facility. There is an outdoor activity area available for the residents. Food Service: Kitchen, food preparation area, and storage areas were observed to be clean and sanitary. The food is properly stored in the refrigerator. Pesticides and cleaning supplies are kept away from the food preparation areas. LPA observed an appropriate food supply of two (2) days of perishables and seven (7) days of non-perishables. Incidental Medical & Dental: Medication is properly labeled and are centrally stored in a closet and are in their original containers. LPA reviewed six (6) residents’ medications and there were no issues observed. The first-aid kit is fully stocked w/first-aid manual. Resident Records-Incident Reports: Resident files are kept in a secure location (within staff room/office). LPA reviewed (6) Resident Files which includes the Face Sheet, Functional Capability Assessment, Appraisal Needs & Services Plan, Admission Agreements, Identification & Emergency Information, current Physician's Report, Ambulatory Status, TB Clearance, and Personal Rights. LPA reviewed Resident’s P&I. Disaster Preparedness: The facility has an Emergency Disaster Plan with contact numbers and at least two (2) relocation sites. Residents with Special Health Needs: There are no bedridden or residents with postural supports at this facility. Per the Administrator, there is no resident at this home with incidental medical services nor have a restricted health condition. Per California Code of Regulations, Title 22, and California Health and Safety Code, the deficiencies observed during the visit are documented on the LIC809-D. Exit interview, appeals rights and a copy of this report were provided to the Administrator Staci Mitchell.the state’s words, verbatim · CDSS document, Jan 15, 2026

Allegation investigated: Staff actions are making residents feel uncomfortable.

Licensing Program Analyst (LPA) Jose Villalobos conducted an unannounced complaint investigation visit for the allegation listed above. LPA met with Administrator Staci Mitchell and the purpose of the visit was discussed. On todays visit LPA conducted the following: LPA toured the physical plant, LPA interviewed staff #1-#4 (S1-S4), Staff #5 no longer works in the facility and was unavailble for interview, LPA interviewed Residents #1-#6 (R1-R6), LPA collected a copy of the staff and resident roster as well as documents from R1's and S5's file related to the allegation. The investigation revealed the following: Conitnued on LIC 9099-C Unsubstantiated In regards to the allegation "Staff actions are making residents feel uncomfortable." it is alleged that S5 has inappropriate conversations around the residents making them feel uncomfortable. (4) of (4) Staff interviewed denied the allegation. (6) of (6) Residents interviewed could not corroborate the allegation. Interviews with staff stated that on 1/27/25 , R1 brought up that they overheard S5 having a political conversation with another staff that made them feel uncomfortable. The conversation was in private between (2) staff away from the residents. This was the only instance a resident expressed any possible issue with staffs conversations and it was addressed with S5 the same day. Interview with residents did not show that they had ever been made to feel uncomfortable by staff. R1 stated they had no issues with any conversations between staff and has never felt uncomfortable at the home. Based on interviews, observations and file review, there was not enough supportive evidence to concur with the reported allegation. Although the allegation may have happened or are valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is UNSUBSTANTIATED. Exit interview held, and a copy of this report was provided.the state’s words, verbatim · CDSS document, Feb 6, 2025 · control 28-AS-20250203172136

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Bennette Pena conducted an unannounced Required-1 year visit. Upon arrival, no one answered the door and LPA called the Administrator & Licensee. At 10:10am, Brandon Dewalt, arrived and explained the purpose of the visit. At 10:30am, Staci Mitchell, Administrator arrived and assisted LPA with the inspection. The facility is licensed to serve six (6) ambulatory adults 60 years of age or older with developmental disabilities. The facility is vendorized by the Frank D. Lanterman Regional Center, Level 4 home. Current census is (8) because of (2) extra residents from their sister facility, Pasa Alta East (3280 N. Fair Oaks Ave., Pasadena, CA. 91101) that was burned down in the Eaton fire. LPA notified Administrator to contact the Fire Dept. to inform them that they are over capacity and are temporarily providing care for (2) additional residents. LPA inspected the facility using the Compliance and Regulatory Enforcement (CARE) tool and observed the following: Infection Control: Staff are adhering to infection control requirements. The staff use disposable gloves to clean and disinfect the high touched surfaces in the common areas. Facility has sufficient PPE supplies and has an Infection Control Plan maintained at the facility. Physical Plant/Environment Safety: The facility is a single-story home which consists of: living room, dining area, kitchen, 4 bedrooms (3 residents and 1 staff), 3 bathrooms, laundry area and front yard. Resident bedrooms were inspected and closet/drawer space to accommodate each resident comfortably was available. The bathrooms are clean and operational. The hot water temperature was tested throughout the facility. Water temperature reading measured within the required 105 - 120 degrees Fahrenheit. Readings were 109.7 deg F in bathroom #1, 107.6 deg F in bathroom #2 and 109 deg F in bathroom #3. The kitchen was observed for the ability to prepare and serve food. LPA observed sufficient food supply of (2) days of perishables and (7 days) of non-perishables. Knives, disinfectants, and cleaning solutions are kept locked and inaccessible to residents. Smoke detectors and carbon monoxide detectors were tested and operable. (2) fire extinguishers were fully charged and last serviced on 06/27/2024. The first-aid kit is fully stocked w/first-aid manual. The front yard is free of debris/hazards and the outdoor and passageways are free of obstruction. A shaded area with chairs is provided in the back yard. The backyard is free of debris/hazards. There is no evidence of bodies of water (pool) or security bars nor weapons on the premises. There are no security bars or weapons on the premises. LPA observed cameras in the common areas with no audio. All storage areas for cleaning solutions, toxins, knives, and hazardous items are kept in a locked cabinet and are inaccessible to residents. Last fire drill was conducted on 01/21/2025 and disaster drill was conducted on 01/31/2025. Operational Requirements: The facility has an approved fire clearance, there is a plan of operation with required Infection Control Plan and facility maintains the required liability insurance. Surety Bond in the amount of $5000 is in effect and expires on 11/09/2025. *****REPORT CONTINUED ON LIC809-C***** Staffing: A total of twelve (12) staff members including the Administrator and Licensee provide care and supervision to the residents. Staff employed are over the age of 18 and have criminal background clearance, fingerprint cleared, have training and associated to the facility. Personnel Records-Training: Staff has criminal record clearance, current First-Aid/CPR training. LPA reviewed (3) staff files with no issues observed. Administrator Staci Mitchell’s certificate expired on 1/20/24 but was able to provide proof of pending renewal and all current training were within the personnel file. Resident Records-Incident Reports: Resident files are kept in a secure location (within staff room/office) and have the following documents in their files - Pre-admission appraisal/Appraisal Needs & Services Plan, Admission Agreements, Identification & Emergency Information and current Physician's Report. LPA reviewed (6) Resident Files with no issues observed. Residents Rights-Information: Residents are provided with telephone and internet at the facility. The facility has the following posters posted: Residents Rights, Complaint Poster, and Ombudsman. Planned Activities: Facility provides scheduled activities and have a variety of activities to choose from within the facility. There is an outdoor activity area available for the residents. Food Service: The kitchen was observed for the ability to prepare and serve food. LPA observed an appropriate food supply of two (2) days of perishables and one week (7) days of non-perishables. Incidental Medical & Dental: Medication is properly labeled and are centrally stored in a closet and are in their original containers. LPA reviewed (6) residents’ medications and there were no issues observed. Disaster Preparedness: The facility has an Emergency Disaster Plan with contact numbers and at least (2) relocation sites. Residents with Special Health Needs: There are no bedridden or residents with postural supports at this facility. Per the Administrator, there is no resident at this home with incidental medical services nor have a restricted health condition. No deficiencies cited, Technical Assistance issued. Exit interview held and a copy of the report was provided to the Administrator Staci Mitchell.the state’s words, verbatim · CDSS document, Feb 3, 2025

The state marks this report as 3 pages; the online copy we transcribed has 2. You can request the full file from the county licensing office.

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Tena Herrera conducted the required annual inspection. LPA arrived unannounced, upon arrival there was no one on site as all residents were away at day program shortly after LPA was greeted by Staci Mitchell (Administrator) and the purpose for today’s visit was explained. The facility is licensed to serve 6 ambulatory residents ages 60 and above. The facility currently has 6 residents, all of which are serviced through regional center. The facility is a single-story home located in Pasadena, Ca. A tour of the facility includes: living room, dining area, kitchen, 4 bedrooms (3 client and 1 staff), 3 bathrooms (2 client and 1 staff), laundry area and front yard. LPA utilized the Compliance and Regulatory Enforcement (CARE) tools for the visit todays visit and the initial visit and observed the following: Infection Control: The facility staff are using appropriate hand hygiene and gloves while assisting residents’ medications. Staff are cleaning and disinfecting throughout the day. Facility has sufficient PPE supplies and has an Infection Control Plan maintained at the facility. Operational Requirements: The facility has an approved fire clearance, there is a plan of operation with required Infection Control Plan and facility maintains the required liability insurance. Physical Plant & Environment Safety: LPA toured facility, residents’ bedrooms were checked and closet/drawer space to accommodate each resident comfortably was available. The front yard is free of debris/hazards and the outdoor and passageways are free of obstruction. No bodies of water were observed at the facility. There are no security bars or weapons on the premises. Hygiene products are readily available for residents. The hot water temperature was tested throughout the facility and measured within the required range of 105-120 degrees F. All storage areas for cleaning solutions, toxins, knives, and hazardous items are kept in a locked and are inaccessible to residents. Smoke detectors and carbon monoxide detectors are operable and in compliance. There fire extinguisher was observed and is fully charged. Last fire/disaster/earthquake drill was conducted on 12/12/23. (Continued on 809-C) Staffing: There appears to be sufficient staffing at all times in the facility. With night staff that is trained and able to assist in care and supervision of the residents in the case of an emergency. Personnel Records-Training: Staff has criminal record clearance, current First-Aid/CPR/AED training along with training in postural supports, medication assistance, and other ongoing training are documented in personnel files. LPA reviewed 5 staff files with no issues observed. Administrator Staci Mitchell’s certificate expired on 1/20/24 but was able to provide proof of pending renewal and all current training's were within the personnel file. Resident Records-Incident Reports: Resident files are kept in a secure location (within staff room/office) and have the following documents in their files - Pre-admission appraisal/Appraisal Needs & Services Plan, Admission Agreements, Identification & Emergency Information and current Physician's Report. LPA reviewed 4 Resident Files with no issues observed. Residents Rights-Information: Residents are provided with telephone and internet at the facility. The facility has the following posters posted: Residents Rights, Complaint Poster, and Ombudsman. Planned Activities: Facility provides scheduled activities and have a variety of activities to choose from within the facility. There is an outdoor activity area available for the residents. Food Service: The kitchen was observed for the ability to prepare and serve food. LPA observed an appropriate food supply of two (2) days of perishables and one week (7 days) of non-perishables. Incidental Medical & Dental: Medication is properly labeled and are centrally stored in a closet and are in their original containers. LPA reviewed 6 residents’ medications and there were no issues observed. Disaster Preparedness: The facility has an Emergency Disaster Plan with contact numbers and at least 2 relocation sites. Residents with Special Health Needs: There are no bedridden or residents with postural supports at this facility. Per California Code of Regulations, Title 22, and California Health and Safety Code, there were no deficiencies observed during the visit. Exit interview held and a copy of the report was provided to the Administrator Staci Mitchell.the state’s words, verbatim · CDSS document, Jan 30, 2024