198603384-7-28-2026-28-AS-WSHO-DWM3WJ-20260803183650

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198603384
Report Date: 05/14/2026
Date Signed: 07/28/2026 10:51:07 AM

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
10/28/2025 and conducted by Evaluator Glenn Trueman

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20251028091841

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: 198	DATE:	05/14/2026
		UNANNOUNCED	TIME BEGAN:	09:30 AM
MET WITH:	Administrator Thomas Rekowski		TIME COMPLETED:	03:15 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Staff did not provide adequate supervision resulting in resident sustaining a fracture.
Staff did not seek medical attention to resident in a timely manner.

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
11
12
13

The purpose of this report is to amend the original reports dated 5/14/2026 and to remove confidential information from the Complaint Investigation Reports (9099, 9099C and continuation 9099 C) which was issued on 5/14/26.
The following was done on the initial visit conducted on 10/30/25:
LPA requested copies of resident and staff rosters, LPA conducted a tour of the facility and common areas. LPA observed a sufficient supply of perishable and non-perishable foods. LPA observed the residents to identify any signs of neglect, abuse, or other immediate health and safety threats. LPA did not observe any immediate health and/or safety concerns.
On 5/14/2026, Licensing Program Analyst (LPA) Glenn Trueman conducted an unannounced subsequent visit to Pasadena Highlands. Upon arriving at the facility, LPA met with the Administrator Thomas Rekowski and explained the reason for the visit.
At visit 5/14/2026 interviews were conducted with Resident's R2-R12.
Interviews were conducted with the Administrator, Staff S1 and Staff S2.
Investigation was conducted by the Department and completed 04/9/2026 for allegations

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Wei Siew Ho
LICENSING EVALUATOR NAME: Glenn Trueman
LICENSING EVALUATOR SIGNATURE:	DATE: 05/14/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/14/2026

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-20251028091841

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 HIGHLANDS	FACILITY NUMBER: 198603384
	VISIT DATE: 05/14/2026

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

In regards to the allegation Staff did not seek medical attention to resident in a timely manner, based on interviews conducted and information gathered it was revealed by R2-R12 that staff have always assisted immediately to provide care for a resident who may have fallen or in need of additional medical care and staff called 911 immediately.

Staff stated if there is a fall they dispatch a caregiver and med-tech to assess and if there is an injury they call 911.
Also stated if there is an emergency Power of Attorney (POA) and doctor are called. If fall is observed they call 911.
It should also be noted that the Department's investigation concluded that although Resident R1 did not complain of any pain, and no bruises or swelling were noted, Pasadena Highland staff immediately contacted Metro Medical Hospital and requested a medical evaluation. According to Metro Medical Hospice Director of Patient Services, it was confirmed that facility staff were in constant communication and immediately notified hospice staff of any change in condition.

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: Wei Siew Ho
LICENSING EVALUATOR NAME: Glenn Trueman
LICENSING EVALUATOR SIGNATURE:	DATE: 05/14/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/14/2026

LIC9099 (FAS) - (06/04)

Page: 3 of 3

Control Number 28-AS-20251028091841

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 HIGHLANDS	FACILITY NUMBER: 198603384
	VISIT DATE: 05/14/2026

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

Staff did not provide adequate supervision resulting in resident sustaining a fracture and Staff did not
seek medical attention to resident in a timely manner.
Investigation was conducted by the Department and interviews were conducted with the reporting party, facility staff members and Metro Medical Hospice medical staff. Additionally, Metro Medical Hospice records and nurse notes were obtained.
Per the facility staff, during a routine check on October 3, 2025, Resident R1 was found on the mat floor of the bedroom. Staff asked Resident R1 for details of the fall and immediately assessed Resident R1 for any injuries and pain. Staff did not observe any injuries, swelling or redness. Additionally, Resident R1 denied having any pain. Staff immediately contacted Metro Hospice and reported the fall incident. Doctor was also notified. Person (P1) instructed staff to monitor Resident R1 and notify them of any changes in condition. On October 6, 2025, Person 1 (P1) evaluated R1 and noted there was no complaining of any pain, no bruises or fractures were observed. On October 16, 2025, R1 began complaining of left leg pain, and facility staff immediately contacted Person (P1 ) and requested an x-ray. On October 18, 2025, an x-ray was taken. On October 20, 2025, results came back noting that the left femur was osteoporotic with an angulated intertrochanteric fracture.
Person (P1) confirmed that R1 was diagnosed with osteoporotic. There is a possibility that this diagnosis makes R1 more susceptible to bone breakage. Person (P2) was advised by the doctor, that there was no way of proving that R1's fractures were caused by the facility staff negligence or lack of care since R1 is diagnosed with being osteoporotic. Person (P1) confirmed that staff acted accordingly and reported R1's condition in a timely manner. Person (P1) denied having any complaints or witnessing any type of neglect/ lack of care by facility staff. Based on the above information, documentation and statements provided, there is insufficient 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.

SUPERVISORS NAME: Wei Siew Ho
LICENSING EVALUATOR NAME: Glenn Trueman
LICENSING EVALUATOR SIGNATURE:	DATE: 05/14/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/14/2026

LIC9099 (FAS) - (06/04)

Page: 2 of 3