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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198602896
Report Date: 05/05/2026
Date Signed: 05/05/2026 04:01:05 PM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK ASC, 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
04/30/2026 and conducted by Evaluator Daniel Konishi
PUBLIC
COMPLAINT CONTROL NUMBER: 28-AS-20260430152031
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:
05/05/2026
UNANNOUNCEDTIME BEGAN:
09:20 AM
MET WITH:Carolee Hazzard, AdministratorTIME COMPLETED:
04:05 PM
ALLEGATION(S):
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Staff do not ensure resident’s shower floor is not a slipping hazard.

INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Daniel Konishi conducted a unannounced initial complaint visit to investigate the allegations listed above. LPA met with Administrator Carolee Hazzard and the purpose for today’s visit was explained.

The investigation consisted of the following: LPA obtained copies of staff and client rosters. LPA toured the facility and four (4) client bathrooms. LPA interviewed Administrator, Staff #1 (S1) and Staff #2 (S2), Witness #1 (W1) and Client #1 (C1) to Client #7 (C7). LPA attempted to interview Former Staff #3 (FS3) but LPA was unable to interview FS3 as they are no longer the staff of the facility and the phone number on record is no longer FS3’s phone number.

The investigation revealed the following: in regard to the allegation, “Staff do not ensure resident’s shower floor is not a slipping hazard.” It is alleged that on 07/26/2025 there was no slip proof mat in the bathroom which caused C1 to slip and fall and sustained injuries. [Continue to LIC9099-C]
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: David Sicairos
LICENSING EVALUATOR NAME: Daniel Konishi
LICENSING EVALUATOR SIGNATURE:

DATE: 05/05/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/05/2026
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 4
Control Number 28-AS-20260430152031
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK ASC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754
FACILITY NAME: PASADENA GUEST HOME
FACILITY NUMBER: 198602896
VISIT DATE: 05/05/2026
NARRATIVE
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It is also alleged that when the staff takes the mat to dry, staff does not replace it with another mat. LPA interviewed the Administrator and two (2) staff that denied the allegation stating that they cannot recall the incident of C1 slipping sustaining injuries on 07/26/2025. However, the Administrator, and two (2) staff stated that the facility shower floors are safe and are not a slipping hazard as slip proof mats kept in the shower. LPA interviewed C1 that corroborated with the allegation but the C1 stated that the incident occurred on 07/14/2025 and it was reported to Former Staff #3 (FS3). LPA attempted to interview FS3 but was unable to interview because FS3 is no longer the staff of the facility and the phone number on record is no longer FS3’s phone number. LPA reviewed facility SIRs (Special Incident Reports) and there are no SIRs regarding the incident that allegedly occurred on 7/26/2025 or 7/14/2025. During today’s visit, LPA observed that the shower in the bathroom has a slip proof mat. LPA interviewed an additional six (6) clients that denied the allegation that indicated that the showers are safe and not a slipping hazard and that the facility continues to provide slip proof mats in the bathroom shower. There is not enough sufficient evidence to substantiate.

Based on statements and interviews conducted with staff, clients, review of client files and facility file records, there was not enough supportive evidence to concur with the reported allegations. Although the allegations may have happened or is valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegation is UNSUBSTANTIATED.

An exit interview was held and a copy of this report was provided to the Administrator Carolee Hazzard.
SUPERVISORS NAME: David Sicairos
LICENSING EVALUATOR NAME: Daniel Konishi
LICENSING EVALUATOR SIGNATURE:

DATE: 05/05/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/05/2026
LIC9099 (FAS) - (06/04)
Page: 2 of 4
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK ASC, 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
04/30/2026 and conducted by Evaluator Daniel Konishi
PUBLIC
COMPLAINT CONTROL NUMBER: 28-AS-20260430152031

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:
05/05/2026
UNANNOUNCEDTIME BEGAN:
09:20 AM
MET WITH:Carolee Hazzard, AdministratorTIME COMPLETED:
04:05 PM
ALLEGATION(S):
1
2
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9
Facility bathtubs and showers are in disrepair.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Daniel Konishi conducted a unannounced initial complaint visit to investigate the allegations listed above. LPA met with Administrator Carolee Hazzard and the purpose for today’s visit was explained.

The investigation consisted of the following: LPA obtained copies of staff and client rosters. LPA toured the facility and four (4) client bathrooms. LPA interviewed Administrator, Staff #1 (S1) and Staff #2 (S2), Witness #1 (W1) and Client #1 (C1) to Client #7 (C7). LPA attempted to interview Former Staff #3 (FS3) but LPA was unable to interview FS3 as they are no longer the staff of the facility and the phone number on record is no longer FS3’s phone number.

The investigation revealed the following: in regard to the allegation, “Facility bathtubs and showers are in disrepair.” It is alleged that there is only one (1) bathtub and shower currently working for 25 residents.
[Continue to LIC9099-C]
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: David Sicairos
LICENSING EVALUATOR NAME: Daniel Konishi
LICENSING EVALUATOR SIGNATURE:

DATE: 05/05/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/05/2026
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 3 of 4
Control Number 28-AS-20260430152031
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK ASC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754
FACILITY NAME: PASADENA GUEST HOME
FACILITY NUMBER: 198602896
VISIT DATE: 05/05/2026
NARRATIVE
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It is also alleged that the other three (3) bathrooms and showers are in disrepair, one (1) is out of order, one (1) has no water connected, and one (1) has a broken shower head. This allegation was previously investigated and substantiated on 04/14/2026 (Complaint Control #28-AS-20260407083604). This investigation revealed that one (1) tub in bathroom 6 North was inoperable as the knobs were damaged. The shower in bathroom 3 on North side near to the kitchen is inoperable as the flooring needs to be replaced. This bathroom is currently not being used due to the safety risk. LPA interviewed the Administrator, S1 and S2 who confirmed that the shower in bathroom 3 North and bathtub in bathroom 6 North are not used for washing by clients currently as they are in disrepair. The tub in Bathroom 4 South and the shower in bathroom 1 South are operable. During today’s visit, LPA reviewed and confirmed the bathroom numbers and location with the Admin and S1. LPA also toured the facility with Witness #1 (W1) and LPA observed and confirmed with W1 that repairs are still needed on the following bathrooms and showers: bathtub in bathroom 6 North and shower in bathroom 3 North still need repairs. The Proof Of Corrections (POCs) for these repairs are still pending and are due by 05/14/2026. LPA interviewed the Administrator and two (2) staff that corroborated with the allegation stating that there are only (1) bathtub and one (1) shower available and working for 25 residents while the other one (1) bathtub and one (1) shower are inoperable and under construction. LPA interviewed seven (7) clients that corroborated with the allegation stating that there are only one (1) bathtub and one (1) shower available and working while the other one (1) bathtub and one (1) shower are inoperable and under construction. LPA toured the four (4) bathrooms and observed that there are currently one (1) bathtub and one (1) shower available and working for 25 clients while the other one (1) bathtub and one (1) shower are inoperable and still in disrepair. Per administrator, as of today’s date, there has been no progress made on repairs of these two (2) bathrooms. There is enough sufficient evidence to substantiate.

Based on LPA interviews which were conducted and record review, the preponderance of evidence standard has been met, therefore the above allegation(s) is found to be SUBSTANTIATED.

An exit interview was held and the copy of the report and appeal rights were provided to the Administrator Carolee Hazzard.

SUPERVISORS NAME: David Sicairos
LICENSING EVALUATOR NAME: Daniel Konishi
LICENSING EVALUATOR SIGNATURE:

DATE: 05/05/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/05/2026
LIC9099 (FAS) - (06/04)
Page: 4 of 4