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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198602896
Report Date: 04/14/2026
Date Signed: 04/14/2026 05:47:29 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
04/07/2026 and conducted by Evaluator Elena Mallett
PUBLIC
COMPLAINT CONTROL NUMBER: 28-AS-20260407083604
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: 24DATE:
04/14/2026
UNANNOUNCEDTIME BEGAN:
08:10 AM
MET WITH:Administrator Carolee HazzardTIME COMPLETED:
05:30 PM
ALLEGATION(S):
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Facility did not ensure residents shower bath/accomodations were met
Facility did not ensure the central heat was properly working
Facility was in disrepair
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Elena Mallett conducted a unannounced Complaint visit to investigate the allegations listed above. LPA met with Administrator Carolee Hazard and the purpose for today’s visit was explained.


The investigation consisted of the following:

During todays visit LPA Mallett obtained copies of staff/resident rosters.LPA toured ten resident rooms and all 5 resident bathrooms. LPA interviewed Administrator, Staff 1 and 2 (S1-S2) and 5 (R1-R5) residents. The following documents were obtained: facility electricity bills from 03/26.

(Continued on LIC9099-C)
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Fernando Fierros
LICENSING EVALUATOR NAME: Elena Mallett
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 6
Control Number 28-AS-20260407083604
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: 04/14/2026
NARRATIVE
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The investigation revealed the following:
Allegation: Facility did not ensure residents shower/bath accomodations were met.
It is alleged that there was only one working shower for 30 residents. There are currently 24 residents at the facility. 5 out of 5 residents (R1-R5) interviewed stated there was one shower and one bathtub available for washing. It is alleged there was one working bathtub for 30 residents and that had mud coming out of the faucet. LPA tested two bathtubs and two showers. One tub in bathroom 4 North was inoperable as no water came out of the faucet. Both showers were observed to be operable however, the shower 3 on South side near to the kitchen is located in a bathroom with where a large parcel of tiles are missing and there is a large hole on the wall. This bathroom is not used due to the safety risk. Administrator, S1 and S2 confirmed that shower in bathroom 3 South and bathtub in bathroom 4 North are not used for washing by residents. The tub in Bathroom 5 South was operable and no mud came out of the faucet.

Allegation: Facility was in disrepair.


It is alleged that the facility is in disrepair and the residents rooms have holes in the walls, there is dry rot present around the toilets and the central heat was not properly working resulting in the upstairs areas not having heat.It is alleged the hot water for showers was not consistent and that the central heat does not work properly resulting in the upstairs not having a working heater. LPA toured the facility and found several items in disrepair. The restroom downstairs nearest the kitchen, Bathroom 3 south had an entire section of tile missing near the shower entry and a 30 inch long circle of plaster missing from the bathroom wall. Restroom 4 North had a chunk of the wall missing and the tub was not working and there was a crack on floor near toilet Bathroom 6 North has a plate sized dry rot area by the toilet. There were no holes observed in resident room walls but the outside of the door of a client bedroom 11 was splintered and broken. The light bulbs on the North stairwells was not functioning. Regarding the heater not functioning upstairs, 2 out 5 residents confirmed there is not heat upstairs. Administrator acknowledged the heater has not worked upstairs since January 2026 and stated there was no repair order in at the present time to fix it. 5 out 5 residents(R1-R5)_ interviewed stated the facility was not is disrepair and that hot water was available for showers. Administrator and S1 and S2 state hot water is available for showers. S 1 stated the facility always needs repairs but the repairs are made. S 2 stated the facility is in good repair. Administrator Hazzard acknowledged there are items that need to be repaired.




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SUPERVISORS NAME: Fernando Fierros
LICENSING EVALUATOR NAME: Elena Mallett
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 6
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
04/07/2026 and conducted by Evaluator Elena Mallett
PUBLIC
COMPLAINT CONTROL NUMBER: 28-AS-20260407083604

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: 24DATE:
04/14/2026
UNANNOUNCEDTIME BEGAN:
08:10 AM
MET WITH:Administrator-Carolee HazzardTIME COMPLETED:
05:30 PM
ALLEGATION(S):
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Facility did not have electricity for an extended period of time
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Elena Mallett conducted a unannounced Complaint visit to investigate the allegations listed above. LPA met with Administrator Carolee Hazard and the purpose for today’s visit was explained.


The investigation consisted of the following:

During todays visit LPA Mallett obtained copies of staff/resident rosters andstaff facility sketch.LPA toured resident rooms and all 6 resident bathrooms. LPA interviewed Administrator, Staff 1,2 and 5 residents. The following documents were obtained: facility electricity bills from 03/26.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Fernando Fierros
LICENSING EVALUATOR NAME: Elena Mallett
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: 3 of 6
Control Number 28-AS-20260407083604
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: 04/14/2026
NARRATIVE
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Allegation: Facility did not have electricity for an extended period of time. It is alleged that the facility was without electricity at least 5 times due to power company disconnecting power due to non-payment of bill. LPA observed the facility to have electricity. Interviews with Residents (R1-R5) and Staff 1 and 2 did not corroborate there ever being loss of electricity to the facility for any amount of time other than a few hours for a scheduled power outage by the power company. Administrator provided a copy of March utility bill that indicated the facility had made a current payment. Administrator stated electricity had never been cut off from the facility due to non payment of the bill.

Based on observation , record review and interviews this allegation is not supported.

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.

An exit interview was conducted with Administrator Carolee Hazzard and a copy of this Licensing Report was provided.

SUPERVISORS NAME: Fernando Fierros
LICENSING EVALUATOR NAME: Elena Mallett
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: 4 of 6
Control Number 28-AS-20260407083604
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: 04/14/2026
NARRATIVE
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Based on observation and interviews which were conducted and observations made by LPA, the preponderance of evidence standard has been met, therefore the above allegations are found to be SUBSTANTIATED.

Deficiencies were cited today per Title 22. An exit interview was conducted with Administrator Carolee Hazzard and a copy of this Licensing Report and Appeal Rights were provided
SUPERVISORS NAME: Fernando Fierros
LICENSING EVALUATOR NAME: Elena Mallett
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: 5 of 6
Control Number 28-AS-20260407083604
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: 04/14/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
04/28/2026
Section Cited
CCR
80087(a)
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Buildings and Grounds 80087
(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.
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By POC due date Administrator will fax estimates for repairs to be made by repairman to LPA via Office Fax. Repairs will be completed by 05/14/26
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The above requirement is not met as evidenced by Bathrooms 3 South, 4 North, and 6 North have floors, walls and tub that need repairs. Bedroom 11 door needs repairs and north hallway lightbub needs to be fixed. This poses a potential health and safety risk to clients in care.
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Type B
04/28/2026
Section Cited
CCR
85088(b)(2)
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85088 Fixtures, Furniture, Equipment and Supplies
(b) Toilet,washbasin and shower fixtures shall at a minimum meet ...
(2) At least one bathtub or shower shall be maintained for each ten persons residing in the facility.
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By POC due date Administrator make available another tub/shower for use by clients in care and submit proof of this to LPA by fax.
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The above requirement is not met as evidenced by there are 24 residents residing in the facility and there are only two tub/shower available for use. This poses a potential health and safety risk for clients in care.
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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: Fernando Fierros
LICENSING EVALUATOR NAME: Elena Mallett
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: 6 of 6