197602744-3-14-2024-28-AS-LHIS-D4KLUX-20240422090437

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197602744
Report Date: 03/14/2024
Date Signed: 03/14/2024 03:10:01 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 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
03/06/2024 and conducted by Evaluator Jewel Baptiste

COMPLAINT CONTROL NUMBER: 28-AS-20240306155252

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:	09:30 AM
MET WITH:	Administrator Maria Teresita Quizon		TIME COMPLETED:	03:25 PM

ALLEGATION(S):

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Staff do not treat resident with dignity and respect.

INVESTIGATION FINDINGS:

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On 3/14/24 at 9:30 a.m., Licensing Program Analyst (LPA) Jewel Baptiste conducted an unannounced complaint visit to the facility. Upon arrival LPA met with Administrator Maria Quizon and explained the purpose of the visit.

During today’s visit LPA toured the facility with Administrator. LPA obtained resident roster and staff roster. LPA conducted file review for S1 through S3. LPA also interviewed: Administrator and a total of two (5) staff who shall be referred to as S1 through S5. LPA interviewed a total of 10 residents who shall be referred to as: R1 through R10.

Report continued on 9099c

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Lisa Hicks	TELEPHONE: (323) 213-1556
LICENSING EVALUATOR NAME: Jewel Baptiste	TELEPHONE: (323) 400-9594
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)

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Control Number 28-AS-20240306155252

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 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

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The investigation reveals the following: Regarding " Staff do not treat resident with dignity and respect”. It is alleged that S1 is rude and belittles the residents. The Administrator denied the allegation stating staff have never disrespected the residents and none of the residents complained about being disrespected. 5 out of 5 staff denied the allegation, stating they have never seen S1 or any staff disrespect or belittle the residents. 6 out of 10 residents denied the allegation, stating S1 never disrespected them, and they have not witnessed staff disrespect other residents. 4 out of 10 residents do not remember S1. LPA review staff files for S1 through S3 and did not observe disciplinary actions regarding the allegation.

Based on LPA's interviews, investigation revealed: Although the allegation may have happened or is 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 conducted with Maria Quizon and a copy of this record provided.

SUPERVISOR'S NAME: Lisa Hicks	TELEPHONE: (323) 213-1556
LICENSING EVALUATOR NAME: Jewel Baptiste	TELEPHONE: (323) 400-9594
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)

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