198603384-4-23-2026-28-AS-LHIS-DTFSLX-20260424135902

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198603384
Report Date: 04/23/2026
Date Signed: 04/23/2026 11:20:53 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
12/24/2025 and conducted by Evaluator Jewel Baptiste

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20251224122530

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: 86	DATE:	04/23/2026
		UNANNOUNCED	TIME BEGAN:	09:30 AM
MET WITH:	Administrator Thomas Rekowski		TIME COMPLETED:	11:35 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Staff handled resident in rough manner.

INVESTIGATION FINDINGS:

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

On 4/23/2026, Licensing Program Analyst (LPA) Jewel Baptiste conducted an unannounced visit to Pasadena Highlands to deliver findings on the investigation conducted by Investigator / Douglas Real. Upon arriving at the facility, LPA met with the Administrator Thomas Rekowski and explained the reason for the visit
.
The initial visit was conducted on12/30/2025 by LPA Sakinah Madyun regarding the allegation listed above. It consisted of a physical plant tour of the facility's interior and exterior, activity/common areas, and dining room. LPA obtained copies of staff/resident rosters and collected the following copies: Physician reports, medication logs, unplanned incident reports, identification and emergency information face sheets for residents #1-#37 (R1-R37), and an alert chart dated October 2025 through December 2025. LPA also reviewed thirty-seven (37) resident files during the complaint visit. LPA Madyun conducted interviews with two (2) staff and one (1) resident.

Report continued on 9099c

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Lisa Hicks
LICENSING EVALUATOR NAME: Jewel Baptiste
LICENSING EVALUATOR SIGNATURE:	DATE: 04/21/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/21/2026

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 2

Control Number 28-AS-20251224122530

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: 04/23/2026

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

IB Investigator Real interviewed a total of five (5) staff, three (4) residents, and the Nurse practitioner. They also collect R1 medical records from Huntington Hospital and police reports from the Pasadena Police Department.

During todays visit LPA Baptiste interviewed five (5) residents, who shall be known as R5 through R9.

Based on interviews conducted and records reviewed, facility staff interviews revealed that R1 did not initially recall what caused the injury to their arm but later changed their statement and stated the injury occurred while C1 was assisting them out of a wheelchair. R1 denied that C1 intentionally harmed them. C1 denied the allegation and reported that they only transferred R1 with the assistance of other caregivers. None of the caregivers interviewed provided any information to support the allegation and denied witnessing C1 harm or handle R1 in a rough manner. The interviewed residents provided no information to support the allegation. A copy of the relevant police report was obtained, and a review revealed no information supporting the allegation.

Based on interviews and file review, the investigation revealed that, although the allegation may have occurred or be valid, there is not a preponderance of evidence to prove that the alleged violation did or did not occur; the allegation is UNSUBSTANTIATED.

Exit interview conducted with the Administrator Thomas Rekowski and a copy of this record provided.

SUPERVISORS NAME: Lisa Hicks
LICENSING EVALUATOR NAME: Jewel Baptiste
LICENSING EVALUATOR SIGNATURE:	DATE: 04/23/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/23/2026

LIC9099 (FAS) - (06/04)

Page: 2 of 2