On the morning of Jan. 8, Jean Bruce Poole woke up in her Altadena independent living apartment at the MonteCedro retirement home, and like any other day, she got dressed and ate her breakfast.
The 100-year-old knew she couldn’t hear much without her hearing aids — they hadn’t been able to charge due to power outages — but she had no idea that a massive inferno was threatening her building, having already razed much of the neighborhood nearby.
She also didn’t realize that she was almost entirely alone.
“They left my mom,” Poole’s son, John Ward, said in an interview with The Times. He called what happened to his mother during the first hours of the Eaton fire a “terrible breakdown” that requires a full review and several reforms to ensure it never happens again.
Luckily, when Poole made her way into the facility’s smoky hallways that morning — more than three hours after the rest of the senior home was evacuated — two Los Angeles County sheriff’s deputies found her as she struggled to find her way out in the dark, using a walker.
“By the grace of God, within about 30 minutes of being disoriented in the hallway, she hears, ‘Hello hello,’” Ward said. “Can you imagine … if they never walked through? … There are so many good, fortunate things that came together to save her.”
Jean Bruce Poole after she was reunited with her family Jan. 8, hours after she had been left behind during the evacuation of an Altadena senior care facility during the Eaton fire.
(Courtesy of John Ward)
Ward tries not to think what could have happened if those two deputies had not been sent to do a final sweep through the building. Body camera footage from the encounter showed the two deputies first finding another elderly resident attempting to walk her dog, before locating Poole on the third floor of the dark, empty building. In the video, Poole begs the deputies for help: “Don’t lose me!” the centenarian said.
The deputies were able to take both women to safety.
MonteCedro, a nonprofit assisted living facility run by Episcopal Communities & Services, has acknowledged that the two residents were somehow left behind during its chaotic, middle-of-the-night evacuation from the Eaton fire. But the nonprofit also cited its success in moving “nearly 200 people, some with cognitive issues or other impairments, away from their homes in a couple of hours,” according to a statement from James Rothrock, the nonprofit’s chief executive.
However, he also conceded that there were “gaps in our planning and execution that we are working to understand and correct.”
Charlie Rahilly, an official at Episcopal Communities & Services, said that the nonprofit has “retained a nationally recognized fire and life safety consulting firm to conduct a thorough review of events that night and early morning.”
The near-tragedy at this assisted living facility only punctuates a growing list of issues and concerns about haphazard evacuations and poor communication that occurred on the west side of Altadena the night the Eaton fire exploded. There, evacuation orders came at least eight hours — if not longer — after alerts were issued for residents living east of North Lake Avenue, and well after flames threatened the area, according to a Times investigation.
The late evacuation order appeared to add to the chaos at MonteCedro; officials with the assisted living facility noted in their statement that its team worked with firefighters to monitor the situation and eventually started evacuations before they were ordered. However, the facility is located in an area that received the latest orders to leave, issued just before 6 a.m. on Jan. 8, according to records of archived alerts. A block east, residents had been told to evacuate 11 hours prior, at 7:30 p.m. on Jan. 7.
At least 17 people died in the fire, all of whom were found west of Lake Avenue, and more than 9,000 structures burned, though MonteCedro was not among them.
County officials have called for an external review of the evacuation alerts and why west Altadena’s came so late.
Still, Ward said that’s no excuse for how MonteCedro staff responded to the emergency, given that they were responsible for the safety of a vulnerable population and there were indications that flames were near the facility early in the evening on Jan. 7.
“At 10 o’clock, you should have had everybody with their bags packed,” Ward said. “Don’t wait until the fire beats down your door.”
Jason Montiel, a spokesperson for the state’s Department of Social Services, which licensed MonteCedro most recently in 2023, said the agency is conducting an investigation into what happened at the facility, but declined to comment further. He also declined to respond to questions about other assisted living and nursing homes in the area, which were also seen on video having chaotic evacuations.
A few families related to other residents at MonteCedro have echoed Ward’s concerns about the facility’s lack of emergency preparations and leadership failures the night of the fire — something Tony Chicotel, a senior staff attorney for the California Advocates for Nursing Home Reform, said should be top of mind for such providers.
“Facilities are supposed to be prepared for this stuff,” Chicotel said. “They’re supposed to drill for this. … No one should have been left behind, it’s a catastrophic failure.”
He pointed to a similarly chaotic evacuation of a Santa Rosa senior care facility during the 2017 Tubbs fire, that also led to a state investigation that eventually threatened to revoke the facility’s license without increased emergency protocols and heightened regulations. Families with loved ones who lived through that incident filed several lawsuits, claiming the stress from the day changed people forever.
Ward said he doesn’t want to have to file a lawsuit but he needs to make sure what happened to his mother doesn’t happen to anyone else.
“I’m not a litigious person, but I do want change, concrete change,” Ward said. “I am not going to stop until they make all of the changes I’m recommending.”
John Ward with his mother, Jean Bruce Poole, at her 100th birthday party earlier this year.
(Courtesy of John Ward)
He wants to see MonteCedro implement a string of reforms, including forming a family notification system to keep loved ones notified during emergencies, installing a siren or loudspeaker system that can easily reach residents and updating protocols to physically check every single room before any evacuation. MonteCedro officials said all rooms were checked before they left, but Ward called that a lie because his mother was in her room and never found.
“It was a breakdown, they failed to react and failed to prepare,” he said. “They had no extra staff … no family notification.”
In response to concerns that the facility’s account of the evacuation included falsehoods, Rahilly said they were “aware of the claims and have been in [dialogue] with residents and families about the details surrounding the evacuation.”
As Ward got word about the fire near MonteCedro on the evening of Jan. 7, he said he checked in with staff to make sure his mother way safe.
“I was ready to drive over there,” Ward said. However, he said staff assured him around 9 p.m. that the building was built to withstand fire and the blaze was still far away.
But in the morning when he checked back in, he got a panic-inducing update: Most of the senior care facility had been evacuated, but his mother was not with them.
When he tried to press for more details, he was told that everyone had been accounted for except for two residents, his mom included.
“I’m hopping in my car to drive to Pasadena — I don’t know where I’m going to go,” he said.
Luckily, not long into the ride, an unknown number popped up on his phone and his mother was on the line. She confirmed she was OK at the Pasadena Convention Center with the other woman who was left behind at MonteCedro.
Ward breathed a sigh of relief, then called back the staff from MonteCedro to share their whereabouts.
Minutes later, he hugged his mom and took her back to his house, where she shared her shocking account from that morning — which Ward said is still hard to believe, and harder to stomach.
“Nobody’s ever reached out to my mom … to apologize,” Ward said. “That’s inexcusable to me.”
He is hopeful that MonteCedro can remedy the horrific episode, because for the last seven years, he said, it’s been a wonderful home for his mom.
“Day to day they’re phenomenal, but it takes something like this to find out [the facility staff] weren’t prepared,” Ward said. “You totally failed.”
