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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198602896
Report Date: 07/17/2026
Date Signed: 07/17/2026 03:12:44 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
07/16/2026 and conducted by Evaluator Mayra Cota
COMPLAINT CONTROL NUMBER: 28-AS-20260716094337
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:
07/17/2026
UNANNOUNCEDTIME BEGAN:
09:15 AM
MET WITH:Carolee Hazzard, AdministratorTIME COMPLETED:
03:30 PM
ALLEGATION(S):
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Staff did not perform an assessment on a client in care.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA), Mayra Cota, conducted an unannounced 10-day complaint visit to investigate the allegation mentioned above. LPA met with Carolee Hazzard, Administrator, and the reason for the visit was explained.

During today’s visit, LPA toured the common areas of the facility, obtained copies of staff and client rosters and conducted interviews with Staff 1 (S1) and Person 1 (P1). LPA reviewed files for (9) clients and attempted to review facility file for P1; however, the file was not available during visit.

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: 07/17/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/17/2026
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-20260716094337
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: 07/17/2026
NARRATIVE
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Regarding: Staff did not perform an assessment on a client in care.

It is alleged that client was not assessed by their doctor before admission to the facility nor during the period client lived in the facility.

Interview with S1 revealed that P1 was not seen by a doctor for a medical assessment prior to being admitted to live in the home in July 2025. S1 also indicated that P1 was not assessed by their doctor during the period P1 lived in the facility from July 2025 to January 2026. During the time P1 lived in the facility, S1 did not schedule an appointment to have P1 assessed by their doctor. S1 indicated that the Case Management agency that provides services to clients in care was supposed to assist P1 by making an appointment with their medical doctor for an assessment to be completed; however, S1 indicated that the Case Management agency did not follow-up with making the appointment and S1 did not follow-up either. Review of client records revealed that (9) clients do not have a Physician’s Report on file. S1 indicated that the (9) clients have not received a medical assessment for more than a year. Interviews and record review corroborate the allegation that staff did not perform an assessment on a client in care.

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. An exit interview was conducted, and a copy of this report was provided.

SUPERVISORS NAME: Wei Siew Ho
LICENSING EVALUATOR NAME: Mayra Cota
LICENSING EVALUATOR SIGNATURE:

DATE: 07/17/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/17/2026
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 28-AS-20260716094337
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: 07/17/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
08/14/2026
Section Cited
CCR
80069(a)(1)
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80069 Client Medical Assessment
(a) Except for licensees of ARFs , prior to or within 30 calendar days following the acceptance of a client, the licensee shall obtain a written medical assessment of the client, as specified in Section 80069(c), which enables the licensee to determine his/her ability to provide necessary health related services to the client. The assessment shall be used in developing the Needs and Services Plan. (1) The assessment shall be performed by a licensed physician or designee, who is also a licensed professional, and the assessment shall not be more than one year old when obtained.
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Licensee will review the regulation and send LPA a plan on how the facility will ensure that clients are properly assessed prior to being admitted to the facility. Licensee will also send LPA copies of (9) clients' physician reports by POC due date.
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This requirement is not met as evidenced by: S1 stated that P1 was not seen by their doctor for a medical assessment prior to being admitted to live in the home in July 2025. S1 also indicated that P1 was not assessed by their doctor during the period P1 lived in the facility from July 2025 to January 2026. Also, review of records and satement from S1 revealed that (9) out of (15) clients have not received a medical assessment which poses/posed a potential health, safety or personal rights risk to persons 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.
SUPERVISOR'S NAME: Wei Siew Ho
LICENSING EVALUATOR NAME: Mayra Cota
LICENSING EVALUATOR SIGNATURE:

DATE: 07/17/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/17/2026
LIC9099 (FAS) - (06/04)
Page: 3 of 3