198602896-5-22-2026-28-AS-WSHO-DUQSKC-20260604135632

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198602896
Report Date: 05/22/2026
Date Signed: 05/22/2026 03:32:53 PM

Substantiated

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
05/15/2026 and conducted by Evaluator Mayra Cota

COMPLAINT CONTROL NUMBER: 28-AS-20260515104359

FACILITY NAME:	PASADENA GUEST HOME		FACILITY NUMBER:	198602896
ADMINISTRATOR:	HAZZARD, CAROLEE		FACILITY TYPE:	735
ADDRESS:	1025 N. LOS ROBLES AVENUE		TELEPHONE:	(626) 798-0869
CITY:	PASADENA	STATE: CA	ZIP CODE:	91104
CAPACITY:	30	CENSUS:	DATE:	05/22/2026
		UNANNOUNCED	TIME BEGAN:	11:14 AM
MET WITH:	Carolee Hazzard, Administrator		TIME COMPLETED:	03:20 PM

ALLEGATION(S):

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Licensee does not ensure the stair rail is in good repair, resulting in resident falling.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA), Mayra Cota, conducted an unannounced 10-day complaint investigation visit in response to the above-mentioned allegation. LPA met with Carolee Hazzard, Administrator, and the reason for the visit was explained.

The investigation consisted of the following:

During today’s visit, LPA obtained copies of staff and resident rosters, toured the facility with a particular focus on inspecting the stairwells and handrails, conducted interview with Staff 1 (S1) and Client 1 – Client 6 (C1-C6).

The investigation revealed the following:

***Continues on LIC 9099-C***

Substantiated

Estimated Days of Completion:

SUPERVISORS NAME: Wei Siew Ho
LICENSING EVALUATOR NAME: Mayra Cota
LICENSING EVALUATOR SIGNATURE:	DATE: 05/22/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/22/2026

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-20260515104359

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: 05/22/2026

NARRATIVE

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Regarding: Licensee does not ensure the stair rail is in good repair, resulting in resident falling.

It is alleged that on 9/22/2025, client fell down the main stairwell because the railing was damaged, causing client to sustain injury.

Interviews with S1 revealed that clients have not experienced falls or sustained injuries caused by stair handrails in disrepair. S1 stated that no one has reported falling in the facility. S1 further stated that if someone had experienced a fall, everyone living at the facility would have found out about it and reported it immediately. S1 stated, “We are a tight-nit family, and we communicate everything to each other.” However, S1 acknowledged that the handrails in (3) out of the (3) stairwells and staircase in the facility are loose and have not been fixed. Interviews with (6) out of (6) clients indicated that they have not heard of anyone falling and sustaining injury due to the handrails in the stairwells and staircase being in disrepair. Clients further indicated that they do not feel unsafe using the stairs even though the handrails are loose; however, the handrails should be fixed to prevent an accident. LPA inspected (3) out of the (3) stairwells, staircase and handrails and observed the handrails to be in disrepair. Handrails in the two stairwells inside the facility are loose due to not being properly and securely bolted to the wall both on the right and left side. All four handrails are in disrepair for both stairwells. Furthermore, the handrail on the wall for the outside staircase is missing two mounting bolts in the center which secure the handrail to the wall of the building. LPA jolted all the handrails in the three stairwells and stair case and found that slight weight placed on them makes them move significantly. During the investigation LPA could not obtain sufficient information regarding client falling and sustaining injury, however; client interviews and LPA observations corroborated the allegation that licensee does not ensure the stair rail is in good repair.

The preponderance of evidence standard has been met, therefore the above allegation is found to be substantiated. California Code of Regulations (Title 22), is being cited on the attached LIC 9099 D and a Civil Penaly was assessed for REPEAT VIOLATION for $250. An exit interview was conducted with Carolee Hazzard, and a copy of this report, Appeal Rights was provided.

SUPERVISORS NAME: Wei Siew Ho
LICENSING EVALUATOR NAME: Mayra Cota
LICENSING EVALUATOR SIGNATURE:	DATE: 05/22/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/22/2026

LIC9099 (FAS) - (06/04)

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Control Number 28-AS-20260515104359

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
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 05/22/2026

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 05/08/2026 Section Cited CCR 80087(a)	1 2 3 4 5 6 7	80087(a) Buildings and Grounds (a)The facility shall be clean, safe, sanitary and in good repair at all times for the safety and well-being of clients, employees and visitors. The above requirement is not met as evidenced by:	1 2 3 4 5 6 7	Licensee will fix all the forementioned disrepairs by POC due date. Licensee will ensure that all handrails are securely and properly bolted to the the wall and send LPA photos of all the completed repairs by POC due date.
	8 9 10 11 12 13 14	(3) out of the (3) stairwells have handrails handrails in disrepair. Handrails in the two stairwells inside the facility are loose due to not being properly and securely bolted to the wall both on the right and left side. Wall handrail outside staircase is missing two mounting bolts in the center which secures the handrail to the wall of the building.	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: Wei Siew Ho
LICENSING EVALUATOR NAME: Mayra Cota
LICENSING EVALUATOR SIGNATURE:	DATE: 05/22/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/22/2026

LIC9099 (FAS) - (06/04)

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