<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198602896
Report Date: 04/14/2026
Date Signed: 04/14/2026 04:32:12 PM

Substantiated


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
04/07/2026 and conducted by Evaluator Jewel Baptiste
COMPLAINT CONTROL NUMBER: 28-AS-20260407130003
FACILITY NAME:PASADENA GUEST HOMEFACILITY NUMBER:
198602896
ADMINISTRATOR:HAZZARD, CAROLEEFACILITY TYPE:
735
ADDRESS:1025 N. LOS ROBLES AVENUETELEPHONE:
(626) 798-0869
CITY:PASADENASTATE: CAZIP CODE:
91104
CAPACITY:30CENSUS: 25DATE:
04/14/2026
UNANNOUNCEDTIME BEGAN:
09:56 AM
MET WITH:Administrator Carolee HazzardTIME COMPLETED:
04:45 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff mismanaged client's medication
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On 04/14/26 at 09:56 a.m., Licensing Programming Analyst (LPA) Jewel Baptiste conducted an unannounced complaint in conjunction with a case management visit to the facility. Upon arrival, the LPA met with Carolee Hazzard (Administrator) and explained the purpose of the visit.

During the visit, LPA obtained the resident roster, staff roster, a photo of the medication bottles and a video. The facility did not have C1 physcians orders and MAR. LPA interviewed clients #2 through #6 (C2- C6), and C1 was interviewed prior to the visit. LPA interviewed the Administrator, Staff #1, and Staff #2.LPA also reviewed medications with the administrator for a total of 5 clients, referred to as clients #6 through #10.

Report Continued on 9099c
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Lisa Hicks
LICENSING EVALUATOR NAME: Jewel Baptiste
LICENSING EVALUATOR SIGNATURE:

DATE: 04/14/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/14/2026
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 3
Control Number 28-AS-20260407130003
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: PASADENA GUEST HOME
FACILITY NUMBER: 198602896
VISIT DATE: 04/14/2026
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 reveals the following: Regarding " Staff mismanaged client's medication," it is alleged that C1’s medication was missing from the facility. During interviews with the administrator and staff member #1 stated that C1 take narcotics twice a day, but they took them four (4) times a day, which led to the missing medication. LPA reviewed the medication bottles and confirmed that one (1) bottle stated C1 should take the medication two (2) times a day, and another bottle stated C1 should take the medication every six (6) hours. The Administrator stated that they contacted the pharmacy and were told to give C1 the medication; however, the facility never obtained the client's physician’s orders. Staff #1 confirmed that the facility administered C1 Narcotics four (4) times a day. During the medication review.

Based on LPA observations, interviews, and file review, the preponderance-of-the-evidence standard has been met; therefore, the above allegations are found to be SUBSTANTIATED. California Code of Regulations, Title 22, is being cited on the attached LIC9099D.

Exit Interview Conducted with Administrator/ Appeal Rights Provided / A Copy of the Report Issued.

SUPERVISORS NAME: Lisa Hicks
LICENSING EVALUATOR NAME: Jewel Baptiste
LICENSING EVALUATOR SIGNATURE:

DATE: 04/14/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/14/2026
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 28-AS-20260407130003
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: PASADENA GUEST HOME
FACILITY NUMBER: 198602896
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/14/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
04/21/2026
Section Cited
CCR
80075(5)(B)
1
2
3
4
5
6
7
(B) Once ordered by the physician the medication is given according to the physician's directions.

This requirement was not met as evidence by:
1
2
3
4
5
6
7
The facility will ensure all clients has a physcians order on file and come up with a plan on how they will retrive physcians orders of new clients. The plan is due by POC due date.
8
9
10
11
12
13
14
Based on interviews it was confirmed C1 was not given medications as perscribed due to the facility not obtaining a physcians order, which poses an immediate health,
safety, or personal rights risk to persons in
care.
8
9
10
11
12
13
14
1
2
3
4
5
6
7
1
2
3
4
5
6
7
1
2
3
4
5
6
7
1
2
3
4
5
6
7
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISORS NAME: Lisa Hicks
LICENSING EVALUATOR NAME: Jewel Baptiste
LICENSING EVALUATOR SIGNATURE:

DATE: 04/14/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/14/2026
LIC9099 (FAS) - (06/04)
Page: 3 of 3