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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198602896
Report Date: 02/11/2025
Date Signed: 02/11/2025 12:05:34 PM

Document Has Been Signed on 02/11/2025 12:05 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
GREATER LA AC/SC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754
FACILITY NAME:PASADENA GUEST HOMEFACILITY NUMBER:
198602896
ADMINISTRATOR/
DIRECTOR:		HAZZARD, CAROLEEFACILITY TYPE:
735
ADDRESS:1025 N. LOS ROBLES AVENUETELEPHONE:
(626) 798-0869
CITY:PASADENASTATE: CAZIP CODE:
91104
CAPACITY: 30CENSUS: 26DATE:
02/11/2025
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:09 AM
MET WITH:Carolee Hazzard - AdministratorTIME VISIT/
INSPECTION COMPLETED:
12:15 PM
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Licensing Program Analyst (LPA) Tena Herrera conducted an unannounced case management visit regarding a self-reported incident on the relocation of 4 clients from El Molino Manor in Altadena to Pasadena Guest Home due to mandatory evacuation orders from Fire Advisory. LPA met with Carolee Hazzard and explained the purpose of the visit.

During the visit, LPA conducted a health and safety check and no concerns observed. LPA reviewed copies of client and staff rosters. Per interview with Administrator, 4 clients have been relocated to Pasadena Guest Home from El Molino Manor in Altadena. The facility has sufficient beds, hygiene supplies, beddings, and linens. The dining room is large enough to accommodate all clients. The kitchen has sufficient two-day perishable and seven-day non-perishable food supplies. Medications of the clients that have been transferred to Pasadena Guest Home and are stored in a secure location, LPA reviewed all 4 relocated clients medications.

There is sufficient staffing available to provide care for clients. Administrator confirmed all responsible parties for the clients have been notified about the relocation.

An exit interview was conducted and a copy of this report was provided to Administrator Carolee Hazzard.
SUPERVISORS NAME: David Sicairos
LICENSING EVALUATOR NAME: Tena Herrera
LICENSING EVALUATOR SIGNATURE: DATE: 02/11/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/11/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
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