198602896-8-22-2025-28-AS-LHIS-DL5TP3-20250902145339

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198602896
Report Date: 08/22/2025
Date Signed: 08/22/2025 12:57:41 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 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
08/19/2025 and conducted by Evaluator Noemi Galarza

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20250819160941

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: 26	DATE:	08/22/2025
		UNANNOUNCED	TIME BEGAN:	09:50 AM
MET WITH:	Carolee Hazzard, Administrator		TIME COMPLETED:	01:00 PM

ALLEGATION(S):

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Licensee does not ensure that staff follow proper infection control practices.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Galarza conducted an initial 10-day complaint investigation visit to investigate the allegation above. LPA discussed the purpose of the visit with Administrator Carolee Hazzard.

The investigation consisted of: A physical plant inspection of resident rooms, laundry room, common areas, and outdoor designated smoking area was conducted. Residents (R1- R12) and staff (S1- S2) were interviewed. Copies of LIC 500 Personnel Report/Job Title Descriptions and resident roster were obtained.

*Narrative continues next page.

Unsubstantiated

Estimated Days of Completion:

NAME OF LICENSING PROGRAM MANAGER: Lisa Hicks
NAME OF LICENSING PROGRAM ANALYST: Noemi Galarza
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 08/22/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/22/2025

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-20250819160941

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754

FACILITY NAME: PASADENA GUEST HOME	FACILITY NUMBER: 198602896
	VISIT DATE: 08/22/2025

NARRATIVE

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Allegation: Licensee does not ensure that staff follow proper infection control practices. It is alleged that facility staff do a variety of tasks, such as cooking, cleaning, and laundry, and after staff clean things like the bathrooms/toilets, showers, and laundry they go into the kitchen and prepare food without washing their hands or wearing gloves. According to information obtained, staff grab raw food with unwashed and ungloved hands, and then grab other food to cook without washing their hands or putting gloves. Cross contamination of food borne illness or infection is of concern. The complaint also alleges that staff wear open-toed shoes and no aprons while cooking in the kitchen. A total of 12 residents were interviewed. One (1) out of 12 residents stated that they have seen staff handle food without washing their hands. All other residents stated staff wash their hands when handling and preparing food.

Staff interviewed denied the allegation. Per staff interviews, staff are responsible for performing laundry duties, cleaning duties and cooking, and always wash their hands when handling/preparing food in the kitchen. Staff have a large hand sanitizer bottle in the kitchen that is used by staff in the kitchen and through common areas. Hand sanitizer is sprayed on the resident's hands prior to being served all meals. According to staff, there was an incident recently, in which a resident asked staff for a clean fork because there was a piece of cilantro on the plastic fork. The resident was given another fork with ungloved hands and the resident did not like that. Staff stated they always wash their hands after handling other things aside from food. Staff stated they are allowed to wear sandals if needed and sometimes there are staff that wear open toed sandals when performing cleaning tasks, but always wear proper shoes when cooking in the kitchen. There is not enough evidence to support the allegation.

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.

Exit interview conducted with Administrator Carolee Hazard. A copy of the report was issued.

NAME OF LICENSING PROGRAM MANAGER: Lisa Hicks
NAME OF LICENSING PROGRAM ANALYST: Noemi Galarza
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 08/22/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/22/2025

LIC9099 (FAS) - (06/04)

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