198603384-9-20-2025-28-AS-FFIS-DLZUCG-20250930152753

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198603384
Report Date: 09/20/2025
Date Signed: 09/20/2025 12:40:35 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
09/12/2025 and conducted by Evaluator Kimberly Ramirez

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20250912094702

FACILITY NAME:	PASADENA HIGHLANDS		FACILITY NUMBER:	198603384
ADMINISTRATOR:	KAY CANO		FACILITY TYPE:	740
ADDRESS:	1575 E WASHINGTON BLVD		TELEPHONE:	(801) 815-0808
CITY:	PASADENA	STATE: CA	ZIP CODE:	91104
CAPACITY:	245	CENSUS: 215	DATE:	09/20/2025
		UNANNOUNCED	TIME BEGAN:	11:55 AM
MET WITH:	Director of Marketing and Sales- Cynthia Leon		TIME COMPLETED:	01:00 PM

ALLEGATION(S):

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Staff did not provide resident records to resident's authorized representative.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Kimberly Ramirez conducted an unannounced subsequent complaint investigation visit on 09/20/2025, to deliver findings regarding the above allegation. On 09/18/2025, LPA Ramirez conducted an unannounced initial complaint investigation. Due to time constraints, additional interviews needed and additional time to review records, a need further investigation was documented. During today’s visit, LPA Ramirez was greeted by Director of Marketing and Sales- Cynthia Leon and explained the purpose of the visit.

The investigation consisted of the following: LPA Ramirez requested and obtained copies of Staff Roster, copies of the following for Resident#1 (R1): Medical Records request, Authorization Attachment, HIPPA Compliant Authorization for the Release of Patient Information, Durable Power of Attorney, Declaration of Custodian of Records, Admission Agreement, and physical plant tour. LPA Ramirez conducted the following interviews: Staff#1 - 3 interviews (S1 – S3).

SEE 9099-C for continued report.

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Fernando Fierros
LICENSING EVALUATOR NAME: Kimberly Ramirez
LICENSING EVALUATOR SIGNATURE:	DATE: 09/20/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/20/2025

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-20250912094702

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: 09/20/2025

NARRATIVE

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The investigation revealed the following: regarding the allegation “Staff did not provide resident records to resident's authorized representative.” It is alleged that staff did not provide resident#1 (R1’s) authorized representative with resident records that were requested on 08/18/2025. LPA Ramirez obtained a copy of Medical Records request for R1, which requested records for R1’s entire file including not limited to, medical records, business records, relating to any care, treatment diagnosis, prognosis, consultations and/or findings from 01/01/2024 to present. This record request specifically requires records to be certified, provided in electronic format/PDF format and be emailed or uploaded to R1’s authorized representative. Three (3) out of the three (3) staff interviewed denied this allegation. Interview with S1 revealed they did receive an email request for R1’s entire medical and facility file on 08/18/2025. S1 revealed the email they received looked suspicious and S1 was unsure if this was an attempt to get a residents’ confidential information. S1 revealed they consulted with other staff to ensure the request was legitime and if the documents could be released since the request was being made by someone other than R1. Interview with S2 revealed once they received the medical records request from R1’s authorized representative, they forwarded the request to upper management to gather the documents and to ensure the request was legitimate. Interview with S3 revealed the facility never denied providing R1’s resident records to their authorized representative, the facility just needed more time to gather the documents and ensure the request was legitimate since they usually receive these kinds of requests in person. S3 revealed they spoke with the requestor of R1’s file, and the requestor agreed to allow the facility to submit these documents by 09/19/2025. On 09/18/2025, LPA Ramirez received an email confirmation from S3 which indicated R1’s entire medical file and other documents were sent and received by R1’s authorized representative as requested on 08/18/2025. 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.

No deficiencies were cited during this complaint investigation. Exit interview was conducted and a copy of this report was provided.

SUPERVISORS NAME: Fernando Fierros
LICENSING EVALUATOR NAME: Kimberly Ramirez
LICENSING EVALUATOR SIGNATURE:	DATE: 09/20/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/20/2025

LIC9099 (FAS) - (06/04)

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