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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198602244
Report Date: 01/16/2026
Date Signed: 01/16/2026 02:12:49 PM

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
11/12/2025 and conducted by Evaluator Christian Gutierrez
COMPLAINT CONTROL NUMBER: 28-AS-20251112153446
FACILITY NAME:PASADENA ADULT LIVING CENTERFACILITY NUMBER:
198602244
ADMINISTRATOR:GARCIA, RUBYFACILITY TYPE:
735
ADDRESS:1415 N GARFIELD AVETELEPHONE:
(626) 398-9647
CITY:PASADENASTATE: CAZIP CODE:
91104
CAPACITY:136CENSUS: 81DATE:
01/16/2026
UNANNOUNCEDTIME BEGAN:
10:24 AM
MET WITH:Helen Alba Assistant AdministratorTIME COMPLETED:
02:25 PM
ALLEGATION(S):
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Resident needs a higher level of care
Staff did not report incident.
Resident has a tracking device which may be a violation of personal rights
Resident was neglected due to multiple AWOL
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Christian Gutierrez conducted a subsequent complain visit in regard to the allegations listed above. LPA met with Assistant Administrator Hele Alba who assisted with today’s visit.

The investigation consisted of the following: During the initial visit conducted on 11/18/2025 LPA obtained copies of the following documents: Staff roster, resident roster, and R1’s identification and emergency form LIC 601, physicians report LIC 602, appraisal needs and service LIC 625, SIR reports, La Found device form, Pasadena Police report numbers, and hospital discharge paperwork. On today’s visit LPA Gutierrez interviewed Assistant Administrator, staff 1-4 (S1-S4), clients 2-7 (C2-C7), and delivered findings.

SEE LIC 9099C
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: David Sicairos
LICENSING EVALUATOR NAME: Christian Gutierrez
LICENSING EVALUATOR SIGNATURE:

DATE: 01/16/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/16/2026
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 2
Control Number 28-AS-20251112153446
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: PASADENA ADULT LIVING CENTER
FACILITY NUMBER: 198602244
VISIT DATE: 01/16/2026
NARRATIVE
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In regard to the allegation “Resident needs a higher level of care”, it is alleged mother has expressed to facility and social worker that client may need a higher level of care due to the multiple AWOLs. During interviews with Assistant Administrator and staff five (4) out of five (5) staff stated that C1 may need a higher level of care. Staff stated that C1 has been a resident since 2018 and only recently been showing signs of a higher level of care needed. S1 stated they have been working with C1’s case manager and are in the process of finding a facility to better assist his/her needs. LPA was able to obtain emails between the facility and case manager about getting the care the client needs. During interviews with clients six (6) out of seven (7) believe they receive the level of care they need. C7 felt they were not getting enough toothpaste, so his/her care was not being met.

In regard to the allegation “Staff did not report incident.”, it is alleged that staff did not report AWOLs to appropriate agencies. During interviews with Assistant Administrator and staff five (5) out of five (5) stated they reported all incidents to required agencies. LPA obtained copies of police report business cards with numbers, and special incident reports (SIR’s) report to licensing.

In regard to the allegation “Resident has a tracking device which may be a violation of personal rights”, it is alleged that C1 has tracking device on body and may be a personal rights violation. During interviews with Assistant Administrator, and staff six (6) out of five (6) staff stated that C1 has a tracking device provided by La Found, an organization through LA County that assist local law enforcement to find missing or at-risk individuals. S1 stated that the mother signed C1 up for the device after the multiple AWOLs. All staff stated that C1’s was aware of the watch-like device. LPA was able to obtain documents from La Found with mother’s signature. During interviews with clients six (6) out of seven (7) stated they do not have a tracking device.

In regard to the allegation “Resident was neglected due to multiple AWOL”, it is alleged that C1 was neglected due to having multiple AWOLs. During interviews with Assistant Administrator and staff five (5) out of five (5) staff stated they do not neglect clients. Assistant Administrator stated that C1’s physician report (LIC 602) states C1 can leave facility unassisted. Staff stated there is a sign out sheet in front of office that all clients are told they need to complete. Staff stated that every time C1 AWOLs all necessary procedures are done. During interviews with clients six (6) out of seven (7) stated that they tell staff when they will be leaving if it’s for multiple days. Clients stated that there is a sign out sheet in front office.

Based on interviews conducted and records reviewed, there is insufficient evidence to support the allegations. Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are UNSUBSTANTIATED. An exit interview was conducted, and a copy of this report was given to Helen Alba.

SUPERVISORS NAME: David Sicairos
LICENSING EVALUATOR NAME: Christian Gutierrez
LICENSING EVALUATOR SIGNATURE:

DATE: 01/16/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/16/2026
LIC9099 (FAS) - (06/04)
Page: 2 of 2