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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198602244
Report Date: 04/16/2026
Date Signed: 04/16/2026 02:10:27 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
04/13/2026 and conducted by Evaluator Mayra Cota
COMPLAINT CONTROL NUMBER: 28-AS-20260413141316
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: 78DATE:
04/16/2026
UNANNOUNCEDTIME BEGAN:
08:30 AM
MET WITH:Ruby Garcia, AdministratorTIME COMPLETED:
02:20 PM
ALLEGATION(S):
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Staff does not safeguard resident's belongings.
Staff does not ensure resident receives minimum personal and incidental needs allowance.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA), Mayra Cota, conducted an unannounced 10-day complaint visit to investigate the above-mentioned allegations. LPA met with Ruby Garcia, Administrator, and the reason for the visit was explained.

The investigation consisted of the following:

During today’s visit, LPA obtained copies of staff and resident rosters, toured the facility, conducted interviews with Staff 1 – Staff 6 (S1-S6), Resident 1 – Resident 8 (R1-R8) and Person 1 (P1). LPA also obtained copies of R1’s Facesheet, Physician’s Report, Identification and Emergency Information (LIC 601), Record of Client’s/Resident’s Safeguard Cash Resources (LIC 405) for January – April 2026, facility’s bank account deposit logs for January – April 2026, R1’s rental agreement and Supplemental Security Income Notice.

The investigation revealed the following: ***Continues on LIC 9099-C***
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Wei Siew Ho
LICENSING EVALUATOR NAME: Mayra Cota
LICENSING EVALUATOR SIGNATURE:

DATE: 04/16/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/16/2026
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 3
Control Number 28-AS-20260413141316
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: 04/16/2026
NARRATIVE
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Regarding: Staff does not safeguard resident's belongings.

It is alleged that other residents are stealing resident’s money, clothing and shoes.

Staff deny the allegation. Interviews with (6) out of (6) staff indicated that they have not received reports from residents regarding other residents stealing their money, clothing and shoes. Staff indicated that when residents report lost items, staff help residents look for them. Staff indicated that the facility has protocol which consists of helping residents look in their room or around the facility for their lost items. When things come up missing, staff communicate with other staff so that everyone can be aware and look around the facility. Staff stated that most of the time, residents find their lost items in their rooms after conducting research with staff’s help. Staff further indicated that R1 has not reported that residents are stealing their money, clothing and shoes and has not reported having issues with roommate or other residents. LPA, attempted to conduct interview with R1; however, R1 refused to talk to LPA during visit. Interview with P1 indicated that R1 has not expressed concern regarding the safeguarding of R1’s belongings at the facility. P1 also indicated that R1has not reported having any issues with their roommate or other residents living at the facility. Interview with (7) out of (8) residents indicated that they have no concerns regarding the safeguarding of their belongings at the facility. Based on interviews conducted, there is insufficient evidence to corroborate the allegation that other residents are stealing resident’s money, clothing and shoes.

Regarding: Staff does not ensure resident receives minimum personal and incidental needs allowance.

It is alleged that staff is only providing resident with $20 a month.

Interview with S1, who is the only staff who manages resident’s funds, revealed that R1 receives $20 of Personal and Incidental (P&I) allowance a month due to Social Security Administration (SSA) withholding monies for overpayment on R1’s account. S1 indicated that the facility receives R1’s funds from SSA via direct deposit into the facility’s corporate account, and from there, R1’s rent is paid. Then, the remaining balance of $20 is “noted in the books” for P&I which R1 has been receiving every month. S1 acknowledges that the amount may seem low for R1; however, the amount R1 is left with for P&I is calculated by SSA. S1 further indicated that R1 has not complained about only receiving $20 every month. LPA reviewed R1’s Record of Client’s/Resident’s Safeguard Cash Resources (LIC 405) for January – April, 2026 and did not observe any discrepancies with R1’s monies. Review of facility’s bank account deposit log indicated that from January – April 2026, R1 has received their monthly Supplemental Security Income (SSI) in the amount of $1,463.47.

***Continues on LIC 9099-C page 2***

SUPERVISORS NAME: Wei Siew Ho
LICENSING EVALUATOR NAME: Mayra Cota
LICENSING EVALUATOR SIGNATURE:

DATE: 04/16/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/16/2026
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 28-AS-20260413141316
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: 04/16/2026
NARRATIVE
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Log indicates that after R1’s payment for rent is collected in the amount of $1,444.04, R1 has a balance of $19.40 which is allotted for P&I money, every month. Further review of R1’s records revealed that R1 received a letter from SSA on 11/30/2025 which indicates that R1’s SSI monthly payment after the overpayment withholdings is calculated amounts to $1,463.47. Furthermore, R1’s rent agreement indicates that R1’s rent rate is $1,444.07 a month and after rent is collected, R1 has a balance of $19.40 for P&I. LPA attempted to conduct interview with R1; however, R1 declined to talk to LPA. Interview with (7) out of (8) staff indicated that they have no concerns with how the facility is managing their funds. Interviews and review of records could not corroborate the allegation that resident is receiving minimum personal and incidental needs allowance.

Although the allegations may have happened or are valid, there is no preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are unsubstantiated. An exit interview was conducted with Ruby Garcia, Administrator, and a copy of this report was provided.

SUPERVISORS NAME: Wei Siew Ho
LICENSING EVALUATOR NAME: Mayra Cota
LICENSING EVALUATOR SIGNATURE:

DATE: 04/16/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/16/2026
LIC9099 (FAS) - (06/04)
Page: 3 of 3