<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197602744
Report Date: 06/13/2024
Date Signed: 06/13/2024 03:45:54 PM

Document Has Been Signed on 06/13/2024 03:45 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
GREATER LA AC/SC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754
FACILITY NAME:TERRACES AT PARK MARINO, THEFACILITY NUMBER:
197602744
ADMINISTRATOR/
DIRECTOR:
MARIA TERESITA QUIZONFACILITY TYPE:
740
ADDRESS:2587 E. WASHINGTON BLVD.TELEPHONE:
(626) 798-6753
CITY:PASADENASTATE: CAZIP CODE:
91107
CAPACITY: 112CENSUS: 94DATE:
06/13/2024
TYPE OF VISIT:Case Management - Annual ContinuationUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:50 PM
MET WITH:Maria Quizon - Administrator TIME VISIT/
INSPECTION COMPLETED:
04:00 PM
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
Licensing Program Analyst (LPA) Mary Flores conducted an unannounced continuation annual visit at the facility. LPA met with Maria Quizon and explained the reason for the visit.

On 6/6/24 LPA Flores conducted an initial annual visit.

During today's visit LPA concluded the following domains from the CARE inspection tool:
Finished Infection Control by reviewing training, emergency questions, and that staff have TB test clearance on file. Staffing, Personnel Records/Staff Training, Disaster Preparedness, Residents with Special Health Needs.

LPA reviewed 6 staff files, Emergency Disaster Plan which was last reviewed on 4/2/24. Infection Control Plan was last reviewed on 2/16/24. Last disaster drill was conducted on 5/29/24 and are conducted within 1-3 months.

Administrator certificate was observed for Maria Quizon #7002029740 exp. date: 9/28/25.
A copy of liability insurance was obtain on 6/6/24.

Interviews were conducted with 4 staff and 4 residents.

No deficiencies were cited during this visit.

Exit interview was conducted and a copy of this report was provided.
SUPERVISORS NAME: Tony Vasallo
LICENSING EVALUATOR NAME: Mary G Flores
LICENSING EVALUATOR SIGNATURE: DATE: 06/13/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/13/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 1