197602744-3-20-2024-28-AS-TVAO-D3QM8A-20240326092245

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197602744
Report Date: 03/20/2024
Date Signed: 03/20/2024 11:14:34 AM

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
03/14/2024 and conducted by Evaluator Mary G Flores

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20240314134814

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: 90	DATE:	03/20/2024
		UNANNOUNCED	TIME BEGAN:	08:29 AM
MET WITH:	Teresita Villalvaso - Front Desk		TIME COMPLETED:	11:30 AM

ALLEGATION(S):

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Facility staff is restricting resident from seeing a visitor.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Mary Flores conducted an unannounced complaint investigation visit regarding the above allegation. LPA met with Teresita Villalvaso and explained the reason for the visit. Administrator arrived 20 minutes later.

The investigation consisted of the following: LPA requested copies of staff and resident roster. LPA interviewed 7 residents and 5 staff and requested copies of visitor’s sign in log, and visitor’s policy notice for staff.

The investigation revealed the following: Regarding allegation: Facility staff is restricting resident from seeing a visitor. It is alleged administrator will not let resident’s visitor, who is a past employee come and see the resident. Interviews with residents revealed that residents are aware of visiting policy and receive visitors at the facility. Visitations have not been restricted for any of the residents. 2 out of the 7 residents mentioned that they have been visit by former staff, who visit them, and they visit outside the lobby.
(CONTINUED ON LIC 9099C)

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Tony Vasallo	TELEPHONE: (818) 419-8131
LICENSING EVALUATOR NAME: Mary G Flores	TELEPHONE: (323) 981-3965
LICENSING EVALUATOR SIGNATURE:	DATE: 03/20/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/20/2024

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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Control Number 28-AS-20240314134814

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: 03/20/2024

NARRATIVE

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Per staff interviews, facility allows visitors for residents, unless they have a restraining order, and a particular person is not allowed to visit. Currently there are no unauthorized visitors for any of the residents. Staff may need to check with the residents, or power of attorney when there is a visitor that does not visit regularly to ensure residents desire to have the visitor and/or power of attorney are aware of who is visiting the residents. Per administrator former employees are welcome to visit the residents as long as the resident request the visit upon announcing the visitors to the residents and/or they requested the former employee to come. Administrator is aware that visitations cannot be restricted and accommodates the visits as needed. LPA reviewed visitor sign-in sheet from 3/1/24 to 3/20/24 there were a total of 430 visitors between those days. Resident's Visitors policy was observed as part of residents' admission agreement offering the opportunity for guest to visit and participate in activities.

Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegation is UNSUBSTANTIATED.

Exit interview was conducted with Maria Quizon administrator and a copy of this report was provided.

SUPERVISOR'S NAME: Tony Vasallo	TELEPHONE: (818) 419-8131
LICENSING EVALUATOR NAME: Mary G Flores	TELEPHONE: (323) 981-3965
LICENSING EVALUATOR SIGNATURE:	DATE: 03/20/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/20/2024

LIC9099 (FAS) - (06/04)

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