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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198603286
Report Date: 08/24/2026
Date Signed: 08/24/2026 04:45:35 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
08/05/2026 and conducted by Evaluator Bennette Pena
PUBLIC
COMPLAINT CONTROL NUMBER: 28-AS-20260805102326
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):
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Staff did not safeguard a resident’s belongings.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Bennette Pena conducted an unannounced subsequent complaint investigation regarding the above-mentioned allegation. 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: On 08/14/2026, LPA toured the facility’s common areas, obtained a copy of the staff & resident rosters, Facility’s policies on theft and loss, resident rights, grievance procedures, Staff’s Abuse/Mandated reporting training, Resident #1 (R1) files including: Identification and Emergency Information/Face sheet, Physician’s report, Admission agreement and Appraisal Needs and Services Plan.

During today’s visit, LPA conducted a walkthrough of the common areas and obtained a copy of the staff & resident rosters, R1's Unusual incident/injury report, Invoice/Delivery report for ordered items (July 17, 2026 & July 19, 2026). 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 5
Control Number 28-AS-20260805102326
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
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The investigation revealed the following:

Allegation: "Staff did not safeguard a resident’s belongings." It was alleged that a package for R1 was delivered to the facility on July 19, 2026, with notification that S2 had received it, but the package could not be found. Staff interviewed confirmed that they know that R1 has previously stated that a package that was delivered to the facility is missing. S2 confirmed receiving the package on 07/19/2026 for R1, and stated to have left it on R1's bed in their room the same day. Staff confirmed that they do not have a delivery package tracking system in place or a signed facility inventory list. S1-S2 stated that after R1 complained about the missing package, they started logging the receipt of packages signed by both the residents and facility.
Residents interviewed stated they hardly order items online, and if they do, they receive it themselves. Documents reviewed revealed that R1 ordered items on 07/17/2026 and 07/19/2026 with proof of delivery reports. The facility confirmed receipt of a package for R1 during interviews and documents reviewed, however the package could not be located due to a lack of tracking system or log. Despite the presence of a video camera in the facility, S1 stated that they do not have a video evidence of the package's arrival or S2 delivering it to R1's room. Therefore, there was sufficient evidence to corroborate with this allegation.

Based on staff interviews, resident interviews and record reviews, the preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED. Deficiency cited on the attached LIC 9099D.

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 5
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
08/05/2026 and conducted by Evaluator Bennette Pena
PUBLIC
COMPLAINT CONTROL NUMBER: 28-AS-20260805102326

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):
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Staff threatened to evict resident.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Bennette Pena conducted an unannounced subsequent complaint investigation regarding the above-mentioned allegation. 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: On 08/14/2026, LPA toured the facility’s common areas, obtained a copy of the staff & resident rosters, Facility’s policies on theft and loss, resident rights, grievance procedures, Staff’s Abuse/Mandated reporting training, Resident #1 (R1) files including: Identification and Emergency Information/Face sheet, Physician’s report, Admission agreement and Appraisal Needs and Services Plan.

During today’s visit, LPA conducted a walkthrough of the common areas and obtained a copy of the staff & resident rosters, R1's Unusual incident/injury report, Invoice/Delivery report for ordered items (July 17, 2026 & July 19, 2026). LPA interviewed Staff #1 (S1) – Staff #5 (S5) and Resident#1 (R1) – Resident #7 (R7). ****CONTINUED ON LIC9099-C*****
Unsubstantiated
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: 3 of 5
Control Number 28-AS-20260805102326
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
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The investigation revealed the following:

Allegation: "Staff threatened to evict resident." It was alleged that R1 has never been late on his rent but was told by a staff member that if they do not pay $1420 next month, they will be evicted. Additionally, R1 felt that this in retaliation because of the police report filed for theft. Staff interviewed denied the allegation, stating that R1 was enrolled in an Assisted Living Waiver Program/ALW but has not paid his rent (room & board) since moving in the facility in 2023. S1 stated that they have been trying to collect rent from R1 several times and denied that the attempts to collect rent were retaliatory acts brought on by a police report filed by R1. All residents interviewed denied having been threatened with eviction or retaliation. (2) of (6) residents interviewed stated that they know of other residents who had been evicted due to breaking the facility's house rules or for failing to pay their dues. R1 stated that after filing the police report for theft, they received a verbal eviction warning, without witnesses and that the facility did not provide them with an eviction notice. R1 also confirmed that they have not paid anything to the facility because they were told that Medical would cover their rent instead. Documents reviewed revealed that R1 signed the ALW individual service plan agreement when they moved in on 06/20/2023.

Based on statements and interviews conducted with residents and staff as well as reviewed files and documentation, there was not enough supportive evidence to corroborate the 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 allegation is UNSUBSTANTIATED.

Exit interview conducted and a copy of this report was provided to the administrator, Bryanna Luke.
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: 4 of 5
Control Number 28-AS-20260805102326
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
08/31/2026
Section Cited
CCR
87218(a)(2)
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(a) The licensee shall ensure an adequate theft and loss program.....(2) A licensee who fails to make reasonable efforts to safeguard resident property, shall reimburse a resident for or replace stolen or lost resident property ....The licensee shall.... made reasonable efforts to safeguard resident property ...... to meet each requirement specified in Section 1569.153.
This requirement is not met as evidenced by:
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Administrator agreed to develop a package tracking system or log to be signed by the resident and staff. Administrator also agreed to submit an agreement between staff & R1 that facility will reorder the missing items to replace them. Administrator to send proof/invoice to CCL/LPA by POC due date.
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Based on interviews and record reviewed, Administrator failed to safeguard R1's properties/belongings and cannot locate delivered packages which were confirmed delivered to the facility on 07/17/2026 & 07/19/2026 due to a lack of tracking system or log which poses a potential Health, Safety, and Personal Risk to residents in care.
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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: 5 of 5