198603286-12-30-2025-28-AS-DSIS-DQAUGX-20260113143502

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198603286
Report Date: 12/30/2025
Date Signed: 12/30/2025 02:41:53 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
12/23/2025 and conducted by Evaluator Daniel Konishi

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20251223151118

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: 67	DATE:	12/30/2025
		UNANNOUNCED	TIME BEGAN:	10:10 AM
MET WITH:	Maria Razo, Resident Care Director		TIME COMPLETED:	02:50 PM

ALLEGATION(S):

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Staff consumed alcohol and drugs during work hours, impairing their ability to provide adequate care and supervision which presents a risk to residents
Staff provided resident with alcohol and drugs
Staff did not safeguard resident's personal belongings

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Daniel Konishi conducted a unannounced 10-day complaint investigation visit regarding the above allegations. LPA discussed the purpose of the visit with Resident Care Director, Maria Razo.

The investigation consisted of the following: LPA reviewed and requested copies of Former Resident #1 (R1’s) file documents such as Face Sheet, Physician's Report, Appraisal/Needs and Services Plan, House Rules, and other pertinent documents. LPA also obtained the Staff & Resident Roster, and staff in-service training documents. LPA toured the facility and LPA interviewed Resident #1 (R1) to Resident #8 (R8), and Staff #1 (S1) to Staff #6 (S6).

[Continue in LIC9909-C]

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: David Sicairos
LICENSING EVALUATOR NAME: Daniel Konishi
LICENSING EVALUATOR SIGNATURE:	DATE: 12/30/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/30/2025

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 3

Control Number 28-AS-20251223151118

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: 12/30/2025

NARRATIVE

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The investigation revealed the following: in regard to the allegation "Staff consumed alcohol and drugs during work hours, impairing their ability to provide adequate care and supervision which presents a risk to residents", it is alleged that about one to two years ago, the front desk staff and the administrator drank alcohol and did drugs while working. LPA interviewed R1 which corroborated the allegation by stating witnessing the front desk staff and administrator smoking marijuana and consuming alcohol. However, R1 stated not remembering when this occurred and could not provide any witnesses. Per Resident Care Director’s interview, R1’s moved out on 05/09/2024. LPA interviewed an additional seven (7) residents that denied the allegation stating not witnessing the front desk staff and the administrator and any other staff consume alcohol or do any drugs at the facility. LPA interviewed six (6) out of six (6) staff denied the allegation stated not witnessing the front desk staff, the administrator, or any staff consume alcohol and do drugs at the facility. Six (6) out of six (6) staff also stated not consuming alcohol and not do any drugs at the facility. There is not enough supportive evidence to concur with the reported allegation.

Allegation: “Staff provided resident with alcohol and drugs”, it is alleged that about one to two years ago, the front desk staff gave R1 marijuana and alcohol. LPA interviewed R1 that corroborated with the allegation stating that the front desk staff handed R1 marijuana and alcohol. However, R1 was unable to provide any witnesses and could not remember when the incident occurred. LPA interviewed an additional seven (7) residents that denied the allegation stating not witnessing the front desk staff and any other staff give any alcohol or drugs to a resident. LPA interviewed six (6) out of six (6) staff that denied the allegation stating that they have not witnessed any front desk staff or other staff provide alcohol and drugs to R1 and any other resident. LPA reviewed staff in-service training on Safety and Supervision dated 01/16/2025 in file. There is not enough supportive evidence to concur with the reported allegation.

Allegation: “Staff do not safeguard resident's belongings.” It is alleged that when R1 moved out, R1’s belongings were missing which were five (5) zippered bags, computer, microwave, TV, refrigerator, and coffee maker. LPA interviewed R1 that corroborated with the allegation stating that belongings were missing and stolen by the staff and indicated the following items missing which included five black garbage bags, microwave, TV, computer, and a refrigerator. R1 stated not remembering when this incident occurred. Additionally, R1 did not provide any evidence and did not provide any witnesses stealing the missing items. LPA attempted to interview R1’s former roommate but was unable since R1’s former roommate no longer resides at the facility. LPA reviewed R1’s file and observed the LIC621 Resident Personal Property and Valuables form is blank and signed by R1 stating that R1 waives the right to complete this form.

SUPERVISORS NAME: David Sicairos
LICENSING EVALUATOR NAME: Daniel Konishi
LICENSING EVALUATOR SIGNATURE:	DATE: 12/30/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/30/2025

LIC9099 (FAS) - (06/04)

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Control Number 28-AS-20251223151118

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: 12/30/2025

NARRATIVE

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Per Resident Care Director interview, R1 moved out on 05/09/2024 and R1’s remaining belongings were transferred to R1 by staff from the new home. LPA interviewed an additional six (6) residents that denied the allegation stating that their belongings are kept safe and secure and have not been stolen by staff or gone missing. These additional six (6) residents also stated that they have not witnessed any staff stealing other residents’ belongings at the facility. LPA interviewed an additional one (1) resident that could not confirm nor deny the allegation as they stated their belongings were missing in the past but could not provide any evidence to confirm that the staff stole their belongings. LPA interviewed six (6) out of six (6) staff that denied the allegation stating that they have not stolen R1’s or any other resident’s missing belongings. Six (6) out of six (6) staff stated they did not witness any staff stealing R1’s or any other residents’ belongings. LPA also reviewed staff in-service training on Personal Rights dated 10/27/2025 and Abuse Reporting dated 08/22/2025 in file. There is not enough sufficient evidence to substantiate.

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.

SUPERVISORS NAME: David Sicairos
LICENSING EVALUATOR NAME: Daniel Konishi
LICENSING EVALUATOR SIGNATURE:	DATE: 12/30/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/30/2025

LIC9099 (FAS) - (06/04)

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