198603286-6-10-2025-28-AS-DSIS-DHTKB6-20250620074459

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198603286
Report Date: 06/10/2025
Date Signed: 06/10/2025 01:20:24 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
06/03/2025 and conducted by Evaluator Daniel Konishi

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20250603144912

FACILITY NAME:	PASADENA VILLA SENIOR LIVING		FACILITY NUMBER:	198603286
ADMINISTRATOR:	MURPHY, MICHAEL		FACILITY TYPE:	740
ADDRESS:	1811 N. RAYMOND AVE		TELEPHONE:	(626) 791-6232
CITY:	PASADENA	STATE: CA	ZIP CODE:	91103
CAPACITY:	97	CENSUS: 60	DATE:	06/10/2025
		UNANNOUNCED	TIME BEGAN:	09:09 AM
MET WITH:	Bryanna Luke, Administrator		TIME COMPLETED:	01:25 PM

ALLEGATION(S):

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Staff did not prevent resident in care from engaging in inappropriate interactions with another resident.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Daniel Konishi conducted an Initial 10-Day complaint investigation visit regarding the above allegation. LPA discussed the purpose of the visit with Administrator, Bryanna Luke.

The investigation consisted of the following: LPA reviewed and requested copies of Resident #1 (R1) and Resident #2 (R2's) file documents such as Face Sheet, Physician's Report, Resident Appraisal, Admission Agreement, House Rules, Personal Rights. LPA also requested the Staff & Resident Roster, Special Incident Report. LPA also interviewed R1 to Resident #8 (R8) and Staff #1 (S1) to Staff #5 (S5).

The investigation revealed the following: in regard to the allegation "Staff did not prevent resident in care from engaging in inappropriate interactions with another resident", it is alleged that a R1 is being sexually harassing by R2 by tugging on the R1’s pants and touching bottom of the R1’s body and that the R2 always makes inappropriate comments to R1.

Unsubstantiated

Estimated Days of Completion:

NAME OF LICENSING PROGRAM MANAGER: David Sicairos
NAME OF LICENSING PROGRAM ANALYST: Daniel Konishi
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 06/10/2025

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/10/2025

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

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Control Number 28-AS-20250603144912

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 VILLA SENIOR LIVING	FACILITY NUMBER: 198603286
	VISIT DATE: 06/10/2025

NARRATIVE

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Four (4) out of five (5) staff denied the allegation. One (1) out of five (5) staff could not confirm nor deny the allegation. Four (5) out of five (5) staff stated that R2 is generally friendly, social, and respectful towards residents and staff. One (1) out of five (5) staff indicated that the Pasadena Police Department visited the facility on June 4th, 2025, to conduct a wellness check for a APS report regarding R1. No arrests were made during this visit by the police. Based on record review, R2’s physicians reported indicate that R2 does not engage in inappropriate behavior. R1 and one (1) resident corroborated with the allegation but stated that inappropriate interactions were not reported to the staff. However, R1 stated that after the police visited the facility, R2 has stopped engaging in inappropriate interactions. R2 denied the allegations and stated on never inappropriately touching nor making any inappropriate comments to R1 or other residents. Four (4) out of eight (8) residents interviewed denied the allegation. Two (2) out of eight (8) residents interviewed indicated that after the police visited the facility to speak with R1, R2’s behaviors of inappropriate comments and touching has stopped. One (1) out of eight (8) residents interviewed stated that R2 made an inappropriate comment once but stated that R2 did not ever inappropriately touch another resident.

Based on statements and interviews conducted with staff, residents, review of residents files and facility file records, there was not enough supportive evidence to concur with the reported allegation. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegations are UNSUBSTANTIATED.

Exit interview held, and a copy of this report was provided to the Administrator, Bryanna Luke.

NAME OF LICENSING PROGRAM MANAGER: David Sicairos
NAME OF LICENSING PROGRAM ANALYST: Daniel Konishi
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 06/10/2025

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/10/2025

LIC9099 (FAS) - (06/04)

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