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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198603286
Report Date: 08/05/2025
Date Signed: 08/05/2025 04:26:52 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
07/28/2025 and conducted by Evaluator Daniel Konishi
PUBLIC
COMPLAINT CONTROL NUMBER: 28-AS-20250728185724
FACILITY NAME:PASADENA VILLA SENIOR LIVINGFACILITY NUMBER:
198603286
ADMINISTRATOR:MURPHY, MICHAELFACILITY TYPE:
740
ADDRESS:1811 N. RAYMOND AVETELEPHONE:
(626) 791-6232
CITY:PASADENASTATE: CAZIP CODE:
91103
CAPACITY:97CENSUS: 59DATE:
08/05/2025
UNANNOUNCEDTIME BEGAN:
11:50 AM
MET WITH:Bryanna Luke, AdministratorTIME COMPLETED:
04:30 PM
ALLEGATION(S):
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Staff did not provide resident monthly allowance.
Staff handled resident in a rough manner.
INVESTIGATION FINDINGS:
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Licensing Program Analysts (LPA) Daniel Konishi conducted an unannounced initial complaint visit to investigate the above allegations. LPA met with Bryanna Luke, Administrator and explained the purpose of the visit.

The investigation consisted of the following: LPA obtained and reviewed the staff & resident rosters, valid surety bond, staff in-service training (Residents' Rights, Mandated Reporter Elder Abuse Prevention), and Resident #1 (R1) files such as: Face Sheet, Admission Agreement, and Physician's Report, Rent Invoice (Nov 2024 – August 2025). LPA interviewed the Administrator, Staff #1 (S1) - Staff #6 (S6), and Resident #1 (R1) - Resident #11 (R11).

The investigation revealed the following: In regards to the allegations "Staff did not provide resident monthly allowance." It is alleged that R1 is entitled to receive a $177 monthly personal allowance for clothing/toiletries, provided through R1’s insurance but it has been reported that R1 has not received this allowance from the senior living facility.
Unsubstantiated
Estimated Days of Completion:
NAME OF LICENSING PROGRAM MANAGER: David Sicairos
NAME OF LICENSING PROGRAM ANALYST: Daniel Konishi
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 08/05/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/05/2025
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-20250728185724
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: 08/05/2025
NARRATIVE
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Based on staff interview, the Administrator, business office manager, and five (5) out of five (5) staff denied the allegation. The Administrator and the business office manager stated that when the rent is paid under the assisted living waiver program, there is an amount left for money allowance. However, the facility has not received any rent from R1 from November 2024 to August 2025. Therefore, there is no money allowance. One (1) out of eleven (11) residents corroborated with the allegation. R1 stated that the insurance is R1’s payee and that they are responsible to pay for rent. Unfortunately, R1 could not provide any documents of R1’s insurance information. Based on interview, five (5) out of eleven (11) residents receive money allowance and reported having no issues or problems with receiving money allowance. Based on interview, five (5) out of ten (11) residents reported not receiving money allowance and getting funds from other personal means. There is not enough supportive evidence to concur with the reported allegation.

Allegation: “Staff handled resident in a rough manner.” It is alleged that staff struck a resident while changing the resident’s incontinence brief. One (1) out of eleven (11) residents corroborated the allegation. R1 stated on witnessing other residents got hit by care staff. LPA asked when these incidents occurred and R1 stated that the incidents occurred on Dec 2024 and January 2025. R1 did not report these incidents to the staff. When R1 named the residents that R1 witnessed getting struck by staff, R1 named a resident that no longer lives at the facility. LPA interviewed another resident that R1 named and that resident did not report getting struck by staff. Ten (10) out of eleven (11) residents denied the allegation. Based on staff interview, the Administrator and six (6) out of six (6) staff denied the allegations stating they have not witnessed nor themselves hit or push any resident while providing care. Based on staff interview, the Administrator stated that there are no staff that have been verbally or received a written warning for striking or hitting a resident. LPA obtained and reviewed ongoing staff in-service trainings on resident rights held on 1/7/2025 and mandated reporting elder abuse held on 3/18/2025. There is not enough supportive evidence to concur with the reported allegation.

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.

An exit interview was held, and a copy of this report was provided to the Resident Care Director, Maria Razo.

NAME OF LICENSING PROGRAM MANAGER: David Sicairos
NAME OF LICENSING PROGRAM ANALYST: Daniel Konishi
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 08/05/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/05/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 2