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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198603384
Report Date: 09/12/2025
Date Signed: 09/12/2025 02:41:00 PM

Unsubstantiated


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
09/10/2025 and conducted by Evaluator Elizabeth Irra
PUBLIC
COMPLAINT CONTROL NUMBER: 28-AS-20250910125946
FACILITY NAME:PASADENA HIGHLANDSFACILITY NUMBER:
198603384
ADMINISTRATOR:KAY CANOFACILITY TYPE:
740
ADDRESS:1575 E WASHINGTON BLVDTELEPHONE:
(801) 815-0808
CITY:PASADENASTATE: CAZIP CODE:
91104
CAPACITY:245CENSUS: 212DATE:
09/12/2025
UNANNOUNCEDTIME BEGAN:
12:35 PM
MET WITH:Kay CanoTIME COMPLETED:
02:45 PM
ALLEGATION(S):
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Staff did not safeguard resident's personal belongings.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Elizabeth Irra conducted an initial visit to investigate the above allegation. LPA met with Kay Cano and discussed the purpose of today’s visit.

During this investigation, LPA obtained a copy of the staff and resident rosters, reviewed R-1’s file and obtained relevant documentation, interviewed Staff #1 (S-1) through Staff #5 (S-5) and interviewed Resident #1 (R-1), Resident #4 (R-4) and Resident #5 (R-5) . LPA attempted to interview Resident #2 (R-2) and Resident #3 (R-3) and was unsuccessful. All interviewed residents are residing in the memory care unit (where allegation allegedly occurred) and the census for the memory care unit is (35). LPA was unable to interview additional residents from this unit.

Refer to LIC 9099C for the continuation of this report.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Wei Siew Ho
LICENSING EVALUATOR NAME: Elizabeth Irra
LICENSING EVALUATOR SIGNATURE:

DATE: 09/12/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/12/2025
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 2
Control Number 28-AS-20250910125946
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 HIGHLANDS
FACILITY NUMBER: 198603384
VISIT DATE: 09/12/2025
NARRATIVE
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Allegation: Staff did not safeguard resident's personal belongings. It has been alleged that R-1's wedding ring went missing. LPA obtained a copy of the police report filed with Pasadena Police Department and a copy of the incident report that was sent to this Department (Department of Social Services-Community Care Licensing) for R-1's missing ring. Both reports were sent by facility staff on 09/08/25. (2) out of (3) interviewed residents indicated that their belongings have not gone missing. (2) out of (3) interviewed residents indicated they have not heard anyone complaining about their belongings going missing. (1) out of (3) interviewed residents indicated that they do not recall what happened to their ring. Interviewed staff indicated that they have not received any complaints/concerns pertaining to residents missing their personal belongings (other than this incident). Interviewed staff indicated that staff have searched for R-1's ring in R-1's bedroom and common areas that R-1 frequents and have not found it. Staff interviews also revealed that R-1 receives private care giving services through an outside agency and has different caregivers coming in. Interviewed staff indicated that they are trained in mandated reporting and resident rights. Interviews and documentation do not corroborate this 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, a copy of the Appeal Rights and this report was provided to Kay Cano.




SUPERVISORS NAME: Wei Siew Ho
LICENSING EVALUATOR NAME: Elizabeth Irra
LICENSING EVALUATOR SIGNATURE:

DATE: 09/12/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/12/2025
LIC9099 (FAS) - (06/04)
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