197602744-3-14-2024-28-AS-RORN-D3HLGJ-20240319084445

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197602744
Report Date: 03/14/2024
Date Signed: 03/14/2024 03:05:41 PM

Unsubstantiated

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
03/15/2023 and conducted by Evaluator Tena Herrera

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20230315163209

FACILITY NAME:	TERRACES AT PARK MARINO, THE		FACILITY NUMBER:	197602744
ADMINISTRATOR:	MARIA TERESITA QUIZON		FACILITY TYPE:	740
ADDRESS:	2587 E. WASHINGTON BLVD.		TELEPHONE:	(626) 798-6753
CITY:	PASADENA	STATE: CA	ZIP CODE:	91107
CAPACITY:	112	CENSUS: 91	DATE:	03/14/2024
		UNANNOUNCED	TIME BEGAN:	09:28 AM
MET WITH:	Maria Quizon - Administrator		TIME COMPLETED:	03:20 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Questionable death.
Staff are not preventing the spread of a communicable disease.
Staff are not following proper hand washing.

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
11
12
13

Licensing Program Analyst (LPA) Tena Herrera made an unannounced subsequent complaint visit in response to the above-mentioned allegations. LPA met with Administrator Maria Quizon and explained the purpose of the visit.
The investigation consisted of the following:
During initial visit dated LPA Truman toured facility, obtained a copy of the Staff and Resident Roster, Special Incident Report's (SIR's), Resident Discharge Papers, Line Lists for Department of Public Health (DPH) and Resident Death Reports. No immediate health and/or safety concerns were noted during visit.

During todays subsequent visit LPA Herrera obtained copies of Staff and Resident Rosters, Death Reports from months of Feb/March 2023, Department of Public Health clearance letter for Covid-19 and Gastrointestinal Illness from March 2023, incident reports from Feb/March 2023, weekly in-service training sign in sheets from March 2023, interviewed 10 Residents and 4 Staff.
(CONTINUED ON 9099-C)

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: David Sicairos	TELEPHONE: (323) 981-3982
LICENSING EVALUATOR NAME: Tena Herrera	TELEPHONE: 323-980-4633
LICENSING EVALUATOR SIGNATURE:	DATE: 03/14/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/14/2024

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 2

Control Number 28-AS-20230315163209

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: TERRACES AT PARK MARINO, THE	FACILITY NUMBER: 197602744
	VISIT DATE: 03/14/2024

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

The investigation revealed the following:
Allegation: Questionable death.
It is alleged that the facility had a Covid-19 and Norovirus outbreak during March 2023 and 2 residents died because of this outbreak. LPA interviewed 4 staff and 4 out of 4 staff denied the above allegation and stated that resident deaths during or around that time were not results of either outbreak. LPA reviewed all death reports from February and March 2023 and none of the death reports indicated that these deaths occurred because of Covid-19 or Norovirus/Gastrointestinal viruses, it was documented on the death reports that residents died because of natural causes and there was no other information provided specifying what resident passed and that it was due to facility neglect.

Allegations: Staff are not preventing the spread of a communicable disease; Staff are not following proper hand washing.

It is alleged that staff are not properly sanitizing or washing their hands to prevent the spread of Covid-19 and Norovirus. LPA interviewed 4 staff and 4 out of 4 staff denied the above allegations and stated that during that time the Department of Public Health were visiting on weekly basis to verify proper sanitation was being practiced and encouraged with the residents; staff further stated that facility continues to sanitize, disinfect, practice and promote proper hand washing techniques. Interview with Staff #1 revealed that as a precaution facility continues to test residents and staff on a weekly basis. LPA reviewed in-service training and there were weekly infection control training's being conducted every week during the month of March and per staff these training's are still conducted on a regular basis. LPA received copies of the Department of Public Health clearance letters for Covid-19 and Gastrointestinal Outbreaks from March 2023. Interviews with residents 10 out of 10 residents denied the above allegations and stated that the facility is maintained clean and sanitized, and there are sanitizing stations all throughout the facility. LPA toured facility and observed sanitizing stations throughout hallways and common areas. Per Community Care Licensing records facility reported both outbreaks and clearance letters in a timely manner.

Based on statements/interviews conducted with staff and residents, review of facility records, there was not enough supportive evidence to concur with the reported allegations.

Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are UNSUBSTANTIATED.

Exit interview held, and a copy of this report was provided Administrator Maria Quizon.

SUPERVISOR'S NAME: David Sicairos	TELEPHONE: (323) 981-3982
LICENSING EVALUATOR NAME: Tena Herrera	TELEPHONE: 323-980-4633
LICENSING EVALUATOR SIGNATURE:	DATE: 03/14/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/14/2024

LIC9099 (FAS) - (06/04)

Page: 2 of 2