<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198603286
Report Date: 08/24/2026
Date Signed: 08/24/2026 04:43:18 PM

Substantiated


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
08/18/2026 and conducted by Evaluator Bennette Pena
PUBLIC
COMPLAINT CONTROL NUMBER: 28-AS-20260818132842
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: 64DATE:
08/24/2026
UNANNOUNCEDTIME BEGAN:
09:56 AM
MET WITH:Bryanna Luke - AdministratorTIME COMPLETED:
05:00 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Licensee does not ensure that residents have access to an operable call system.
Staff do not respond to residents' requests for assistance in a timely manner.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst (LPA) Bennette Pena conducted an unannounced subsequent complaint investigation regarding the above-mentioned allegations. LPA met with Anaya Dews, Receptionist and explained the purpose of the visit. Shortly after, administrator, Bryanna Luke arrived and assisted LPA.

The investigation consisted of the following: LPA conducted an observational walkthroughs in the common areas and random residents’ rooms. LPA obtained a copy of the staff & resident rosters, Plan of Operation, Facility’s emergency response plan, Staff training (Residents rights, Abuse/Mandated reporting), and (3) Random resident Individualized Care Plans files. At 11:30am, LPA tested the call lights in room #s 10 & 42. LPA interviewed Staff #1 (S1) – Staff #5 (S5) and Resident#1 (R1) – Resident #7 (R7). ****CONTINUED ON LIC9099-C*****
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Lisa Hicks
LICENSING EVALUATOR NAME: Bennette Pena
LICENSING EVALUATOR SIGNATURE:

DATE: 08/24/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/24/2026
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-20260818132842
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: 08/24/2026
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
The investigation revealed the following:

Allegation: "Licensee does not ensure that residents have access to an operable call system." It was alleged that the facility failed to provide an operable call system for residents, as many lacked call lights or pendants to alert staff. Staff stated that although some call lights are installed, most do not work, and some rooms were still missing them due to painting/renovations. S1 stated that the management has not yet made a decision on their request for an operable call light system. All (7) residents interviewed stated that they have not been provided with a call pendant. During the inspection of (10) rooms, it showed (5) rooms without call lights, and of the (5) rooms that had call lights installed on the wall, (2) were tested and caregivers did not respond. LPA did not observe audible alerts or wearable devices for caregivers to respond to alerts. Documents reviewed revealed that W1's investigation revealed the absence of a pendant/call light in several of the residents' rooms and bathrooms (pictures provided). W1 observed that a hardwired system, which has since been removed and painted over, was previously installed in the wall. Moreover, no signs of audible warnings to caregivers either. Therefore, there was sufficient evidence to corroborate with this allegation.

Allegation: "Staff do not respond to residents' requests for assistance in a timely manner." It was alleged that residents were forced to either use their personal cell phone or call 911 for emergency services because staff were unavailable when called out for help. Staff interviewed stated that caregivers attend residents' calls as quickly as possible and have received training. However, some staff stated that they have heard residents complained to them about not answering the residents' calls for help, especially during the night shift. All (7) residents interviewed corroborated the allegation stating that the call lights installed in their rooms do not work and that they had never received a call light pendant. (5) of (7) residents interviewed stated that they use their cell phones or call out to ask for help instead of a call light system. (2) residents stated that they witnessed other residents call for help during the day and waited for over an hour to get assistance. In order to measure call response times, LPA pushed the call light in Room #10 at 10:25am, and no staff responded after waiting for more than (6) minutes. LPA also tested the call light in Room #42 and received no response from a caregiver after waiting for (5) minutes. Therefore, there was sufficient evidence to corroborate with this allegation.

Based on LPA’s observations, interviews, and record reviews, the preponderance of evidence standard has been met, therefore the above allegations are found to be SUBSTANTIATED.

An exit interview was conducted, and a copy of this report was provided to the Administrator, Bryanna Luke along with the Appeal Rights.

SUPERVISORS NAME: Lisa Hicks
LICENSING EVALUATOR NAME: Bennette Pena
LICENSING EVALUATOR SIGNATURE:

DATE: 08/24/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/24/2026
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 28-AS-20260818132842
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
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/24/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
09/04/2026
Section Cited
CCR
87303(i)(1)-(2)
1
2
3
4
5
6
7
87303 Maintenance and Operation ...(i) Facilities shall have signal systems which shall meet the following criteria: (1) All facilities licensed for 16 or more and all residential facilities having separate floors or buildings shall have a signal system which shall: (2) Facilities having more than one wing, floor or building shall be permitted to have a separate system in each, provided each meets the above criteria.
This requirement is not met as evidenced by
1
2
3
4
5
6
7
Administrator to develop an alternate call system to alert staff if residents need assistance while waiting for a replacement of call light system in the facility. Administrator to submit the plan in writing to CCLD/LPA by POC due date.
8
9
10
11
12
13
14
Based on observation, interviews, records review, the Administrator did not comply with the section cited above in which the facility failed to provide an operable call system for residents, as (5) out of (10) rooms inspected, (Rm #s 8, 10, 18, 22, 24 and 41) lacked call lights or pendants to alert staff which poses a potential health, safety or personal rights risk to residents in care.
8
9
10
11
12
13
14
Type B
09/04/2026
Section Cited
CCR
87411(a)
1
2
3
4
5
6
7
87411 Personnel Requirements - General..(a) Facility personnel shall at all times be sufficient in numbers, and competent to provide the services necessary to meet resident needs. In facilities licensed for sixteen or more, sufficient support staff shall be employed to ensure provision of personal assistance and care as required ....The licensing agency may require any facility to provide additional staff whenever it determines through documentation that the needs of the particular residents, the extent of services provided, or the physical arrangements of the facility require such additional staff for the provision of adequate services.
This requirement is not met as evidenced by
1
2
3
4
5
6
7
Administrator to ensure that facility staff shall at all times be sufficient in numbers, and competent to provide the services necessary to meet resident needs. Administrator to conduct in service training with staff about responding to residents ask for help in a timely manner.
8
9
10
11
12
13
14
Based on observation, interviews, the Administrator did not comply with the section cited above in which the staff were unavailable when called out for help. LPA pushed the call light in Room #10 at 10:25am, and no staff responded after waiting for more than (6) minutes and Room #42, no response from a caregiver after waiting for (5) minutes, which poses a potential health, safety or personal rights risk to residents in care.
8
9
10
11
12
13
14
Administrator to submit the in service training log to CCLD/LPA by POC due date.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Lisa Hicks
LICENSING EVALUATOR NAME: Bennette Pena
LICENSING EVALUATOR SIGNATURE:

DATE: 08/24/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/24/2026
LIC9099 (FAS) - (06/04)
Page: 3 of 3