complaint·May 19, 2025

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) 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.