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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197602744
Report Date: 08/22/2023
Date Signed: 08/22/2023 12:36:10 PM

Unfounded


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
08/15/2023 and conducted by Evaluator Mary G Flores
COMPLAINT CONTROL NUMBER: 28-AS-20230815120156
FACILITY NAME:TERRACES AT PARK MARINO, THEFACILITY NUMBER:
197602744
ADMINISTRATOR:MARIA TERESITA QUIZONFACILITY TYPE:
740
ADDRESS:2587 E. WASHINGTON BLVD.TELEPHONE:
(626) 798-6753
CITY:PASADENASTATE: CAZIP CODE:
91107
CAPACITY:112CENSUS: 93DATE:
08/22/2023
UNANNOUNCEDTIME BEGAN:
11:27 AM
MET WITH:Dana Denham - Health Services Director TIME COMPLETED:
12:45 PM
ALLEGATION(S):
1
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9
Staff allowed dental services to resident without resident's consent.
INVESTIGATION FINDINGS:
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2
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12
13
Licensing Program Analyst (LPA) Mary Flores conducted an unannounced complaint investigation visit regarding the above allegation. LPA met with Dana Denham and explained the reason for the visit.

The investigation consisted of the following: LPA requested copies of resident and staff rosters, interviewed health service director, business office manager, and administrator. During the review of resident roster it was found that resident in question does not reside or resided at the facility. LPA proceeded to request a list of names of residents discharge since 2019.

Based on the information gathered during this visit, the allegation is deemed UNFOUNDED.
A finding of UNFOUNDED means that the allegation is either false, could not have happened, and/or is without a reasonable basis.

Exit interview conducted with Maria Quizon administrator and a copy of this report was provided.
Unfounded
Estimated Days of Completion:
SUPERVISOR'S NAME: Tony VasalloTELEPHONE: (818) 419-8131
LICENSING EVALUATOR NAME: Mary G FloresTELEPHONE: (323) 981-3965
LICENSING EVALUATOR SIGNATURE:

DATE: 08/22/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/22/2023
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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