Altadena senior living community did not follow proper Eaton Fire evacuation procedures, state report says

A state review of an Altadena senior living center found that as the Eaton Fire broke out, facility staff failed to follow proper evacuation procedures for residents.

At the time of the Jan. 7 wildfire, 200 people were living in the MonteCedro senior living and retirement community, and after the campus was evacuated, two residents left behind were found hours later.

One daughter is still demanding answers and accountability, saying the most vulnerable can't be put in a position like that again. Jenny Hontz said her mother and father lived at MonteCedro and both survived the fire, but her mom, who was in a wheelchair and needed around-the-clock care, died a couple of weeks later.

"We lost my mother two and a half weeks after the evacuation. Her health was already declining, but I'm sure the traumatic evacuation didn't help," Hontz said.

As the wildfire raged, residents were rushed out before sunrise. Hontz said her father lived in independent living at the facility, while her mother was in memory care. 

"I called my dad. I said there is a fire, you should get out. He said we're not evacuating; we're sheltering in place," she said.

The California Department of Social Services' report highlighted how thinly staffed the facility was overnight from 11 p.m. to 7 a.m. The five people on site included a building and safety manager, one security guard, two caregivers, and one licensed vocational nurse.

DSS says the executive director, listed as the emergency contact, left around 10:30 p.m. At 11:30 p.m., the report says he called the facility with a "shelter in place" order.

The only person on shift who knew the evacuation procedures was the building and safety manager, who was also handling generators, hoses, and building security. "This was an epic leadership fail," Hontz said.  

"The entrance to Memory Care was blocked by fire, and my dad had to lead the firefighters through the garage up to the elevator so they could safely evacuate," Hontz said.  

DSS noted that after residents reached the Pasadena Convention Center, staff realized two residents were missing. Deputies went back, and a 100-year-old woman was found in a dark hallway and another was found outside, unaware that an evacuation had happened.  

A deputy's body camera caught the moment the 100-year-old resident was found wandering the vacant halls, "Don't lose me," she said.  

The agency said state law requires emergency training, quarterly drills, and workable plans for transportation and accountability. 

Episcopal Communities & Services, which runs MonteCedro, sent CBS Los Angeles a written letter from their CEO, James Rothrock. He says in part, while they do not agree with many of the state's findings, they have made "meaningful improvements" to emergency preparedness. These include updated response tools and drills, enhanced training for staff, stronger coordination with fire and law enforcement and a new emergency communications system for real-time calls, texts and email alerts to residents, families and staff.

David Weidert, the executive director at the time of the Eaton fire, left MonteCedo in February, just before residents returned.

Meanwhile, Hontz wants to see more accountability for leadership failures from the top, specifically from James Rothrock. "For somebody who's making over $600,000 a year at a nonprofit, I expect better," she said.

While some changes have been made, and a new executive director has been named, Hontz says it's not enough when it comes to the care of the seniors. She says she's still waiting for the new emergency plan as promised and wants to see exactly how the most vulnerable will be evacuated next time.

"Most of the people who died in the Eaton Fire were either elderly or disabled… these are our most vulnerable… and we need to do a much better job," Hontz said.