197602744-8-7-2025-28-AS-WSHO-DH3A9Z-20250527000223

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197602744
Report Date: 05/19/2025
Date Signed: 08/07/2025 11:56:15 AM

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
02/14/2025 and conducted by Evaluator Mary G Flores

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20250214161239

FACILITY NAME:	TERRACES AT PARK MARINO, THE		FACILITY NUMBER:	197602744
ADMINISTRATOR:	MARIA TERESITA QUIZON		FACILITY TYPE:	740
ADDRESS:	2587 E. WASHINGTON BLVD.		TELEPHONE:	(626) 798-6753
CITY:	PASADENA	STATE: CA	ZIP CODE:	91107
CAPACITY:	112	CENSUS: 0	DATE:	05/19/2025
		UNANNOUNCED	TIME BEGAN:	11:19 AM
MET WITH:	Maria Quizon - Administrator		TIME COMPLETED:	12:15 PM

ALLEGATION(S):

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Staff did not evacuate resident during mandatory evacuation.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Mary Flores conducted a subsequent complaint investigation visit regarding the above allegation. Due to the Eaton fire facility was destroyed and therefore this visit is being done via telephone. LPA contacted administrator Maria Quizon over the phone and explained the reason for the visit.

The investigation consisted of the following: On 2/19/25 LPA Flores conducted a complaint investigation visit over the phone and interviewed 4 staff. On 2/26/25 LPA contacted Pasadena Fire Department (PFD) to request service logs. On 3/10/25 LPA interviewed 2 additional staff over the phone and attempted to contact PFD fire captain. On 3/12/25 LPA submitted a service request to Pasadena Police department (PPD) and Los Angeles Sheriff Department (LASD). On 3/13/25 LPA conducted a collateral visit and interviewed 7 residents. On 4/7/25, 4/14/25, 4/23/25 LPA contacted PFD fire captain. On 4/25/25 LPA conducted interview with one responsible party over the phone. (CONTINUED ON LIC 9099C)

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Wei Siew Ho
LICENSING EVALUATOR NAME: Mary G Flores
LICENSING EVALUATOR SIGNATURE:	DATE: 05/19/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/19/2025

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-20250214161239

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: TERRACES AT PARK MARINO, THE	FACILITY NUMBER: 197602744
	VISIT DATE: 05/19/2025

NARRATIVE

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On 5/6/25 LPA Flores interviewed 1 additional responsible party and attempted to interview 2 additional responsible parties. On 5/19/25 Fire Captain provided a response to the interview questions. On 5/19/25 LPA delivered findings for the above allegation via telephone.

The investigation revealed the following: Regarding allegation: Staff did not evacuate resident during mandatory evacuation. It is alleged a resident was not removed from the facility on 1/7/25. The following timeline of the events was provided by the staff. On 1/7/25, at around 6:30pm staff observed the fire at the mountain. Business Coordinator met with staff on duty and discuss assigned tasks to coordinate the evacuation. Staff notified residents and responsible parties of residents in placement of the situation. Between 7:00pm – 7:30pm staff began the evacuation process and gather residents in the lobby of the building. At around 8:15pm staff and residents were waiting for fire department instructions to evacuate the building. At around 8:30pm staff were instructed by fire department firefighters to evacuate the building. Between 8:45 pm – 9:15pm staff attempt to gain access to the facility to conduct another check of residents in the floors but were instructed by fire department not to enter the facility. Interviews conducted with 7 residents revealed, 6 out of 7 residents stated they observed the evacuation process, staff knock at residents’ doors, residents were directed to exit the rooms, residents were assisted down the stairs, residents were directed to the lobby for evacuation. Some residents observed other residents being carried down the stairs by staff. One of the six residents stated staff knock at their door and asked them to exit quickly. Two of the six residents confirmed that the facility had conducted evacuation drills in the past. One of the residents stated if the fire alarms went off, they needed to exit the facility and not wait for staff. 1 out of 7 residents stated that on 1/7/25 during the fire was asked by staff to wait in the room for further instructions. 4 out of 7 residents confirmed they left with family members prior the evacuation taking place.

Interviews with staff revealed facility staff became aware of the fire as some had observed the fire begin up in the mountain. Staff began warning residents in their rooms. Off duty staff were called to return to the facility and arrived shortly after. Between 7:30pm – 8:30pm staff began the evacuation process and assisted by knocking at residents’ rooms. They notified residents that they needed to evacuate. Staff carried or assisted residents down the stairs, assembling residents in the lobby. Staff were following fire department’s instructions. Administrator, Maintenance Director, Business Coordinator, Memory Care Director, and Wellness Director stated to have return to the facility at least three times to attempt to do another check of the building.
(CONTINUED ON LIC 9099C)

SUPERVISORS NAME: Wei Siew Ho
LICENSING EVALUATOR NAME: Mary G Flores
LICENSING EVALUATOR SIGNATURE:	DATE: 05/19/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/19/2025

LIC9099 (FAS) - (06/04)

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Control Number 28-AS-20250214161239

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: TERRACES AT PARK MARINO, THE	FACILITY NUMBER: 197602744
	VISIT DATE: 05/19/2025

NARRATIVE

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However, they were instructed by fire department not to enter the building and were notified by firefighters that the last resident was evacuated and was in an emergency service vehicle evacuating the area. Staff stated they did not receive an evacuation notification. Interview with Resident #2 (R2)’s responsible party revealed the facility had an evacuation plan in place and did evacuate residents from the facility safely prior to an evacuation order. Resident #1(R1)’s responsible party stated to have gone into the facility and evacuated their family member themselves. Per R1’s responsible party, R1 does not have cognitive impairment. Interviews were attempted with responsible parties for Resident #3 and #4(R3-R4) but were not successful. Interview with Pasadena Fire Department Fire Captain revealed that due to the circumstances, facility staff took measurements that were successful in the safety of all residents.

LPA was unable to obtain records requested to Pasadena Fire Department and Los Angeles Sheriff Department. Although the allegation may have happened, there were no witnesses that observed the responsible party evacuating R1, at this time there is not enough evidence to support the allegation. LPA was unable to review service logs to establish a timeline of the process of evacuation and the respond time from the fire department. Therefore, this allegation is unsubstantiated.

Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegation is UNSUBSTANTIATED.

Exit interview was conducted with Maria Quizon Administrator over the phone and a copy of this report was emailed for signature.

SUPERVISORS NAME: Wei Siew Ho
LICENSING EVALUATOR NAME: Mary G Flores
LICENSING EVALUATOR SIGNATURE:	DATE: 05/19/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/19/2025

LIC9099 (FAS) - (06/04)

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