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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198603286
Report Date: 04/09/2026
Date Signed: 04/09/2026 10:16:31 AM

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
03/20/2026 and conducted by Evaluator Daniel Konishi
PUBLIC
COMPLAINT CONTROL NUMBER: 28-AS-20260320085012
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: 69DATE:
04/09/2026
UNANNOUNCEDTIME BEGAN:
09:42 AM
MET WITH:Bryanna Luke, AdministratorTIME COMPLETED:
10:20 AM
ALLEGATION(S):
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Staff did not ensure residents pendent was secure and reachable
Due to staff neglect, resident was left in soiled brief for an extended period of time
Due to staff neglect, resident was left in bed/clothes not changed
Staff did not ensure residents air conditioner was working properly
Due to staff neglect, resident was not fed breakfast
INVESTIGATION FINDINGS:
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Licensing Program Analysts (LPA) Daniel Konishi conducted an unannounced subsequent 10-Day complaint visit to investigate the above allegations. LPA met with Bryanna Luke, Administrator and explained the purpose of the visit.

On 3/26/2026, the initial investigation visit was conducted. The investigation consisted of the following:
LPA obtained a copy of the staff and resident rosters. LPA interviewed the Administrator, Staff #1 (S1) to Staff #3 (S3), and Resident #1 (R1) to Resident #11 (R11). LPA obtained documents from R1’s file such as: Face Sheet, Physician’s Report and other pertinent documents. LPA also obtained Staff Training, HVAC maintenance documents, Shift to Shift reports and other pertinent documents.

During today's visit the investigation revealed the following: in regard to the allegation, “Staff did not ensure residents pendent was secure and reachable.” It is alleged that on 03/17/2026, the call light cord was tangled with the cord for bad remote control. [Continued to LIC9099-C]
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: David Sicairos
LICENSING EVALUATOR NAME: Daniel Konishi
LICENSING EVALUATOR SIGNATURE:

DATE: 04/09/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/09/2026
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 4
Control Number 28-AS-20260320085012
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: 04/09/2026
NARRATIVE
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In attempt to detangle cord and lanyard, S1 cut the lanyard leaving call light free floating on client’s bed. It is alleged that R1 has a condition characterized by the inability to control the distance, speed, and power of movements, resulting in overshooting or undershooting targets. As a result, typical movements R1 is likely to knock call light on the floor resulting in inability to request support as needed. LPA interviewed the Administrator and two (2) additional staff that denied the allegation stating that call signals are secure and reachable for all residents. LPA interviewed S1 that denied the allegation stating that R1 requested S1 to cut the cord and the cord to be placed away from the remote control but attached by the bed so R1 is able to reach and use to signal staff for help. LPA interviewed R1 that denied the allegation stating that S1 helped untangle the cord and placed the call signal at a location where S1 can get the call signal and use. During interview with R1, R1 confirmed that R1 asked S1 to cut the cord so that the cords of the call signal and bed remote don’t get tangled. LPA observed that R1 was able to press the call light at 10:11am and care staff arrived in R1’s room at 10:13am. LPA interviewed an additional ten (10) residents that denied the allegation stating that the call light is secure and reachable in their rooms. R1 and the ten (10) residents also stated that the call signals work properly. Administrator, and two (2) out of three (3) staff stated that R1 and all residents pendants are placed in a secure and reachable area and all on-duty care staff carry devices that receive calls. Therefore, there was not enough sufficient evidence to corroborate with the allegation.

Allegation, “Due to staff neglect, resident was left in soiled brief for an extended period of time.” It is alleged that on 03/17/2026, R1 was not changed and left in a soiled diaper until 12:15pm. It is also alleged that on 03/19/2026, R1 was not checked on by afternoon until 9:15pm despite R1 pressing call light. LPA interviewed R1 that denied the allegation stating that on 03/17/2026 and 03/19/2026, R1 was kept dry and staff made sure that R1 was checked on, kept dry, and not wet. LPA interviewed six (6) residents that denied the allegation stating that on 03/17/2026 and 03/19/2026, the staff kept residents dry and were changed frequently. LPA interviewed an additional four (4) residents that could not confirm nor deny the allegation stating that they do not require any incontinence supplies change from the staff. LPA interviewed the Administrator and two (2) staff that denied the allegation stated that incontinence change are provided to all residents in a timely manner. S1 and S2 stated that on 03/17/2026, S1 and S2 conducted a status check every two hours and R1 refused incontinence supply change since R1 was with a guest until 12pm. Ultimately, R1 requested incontinence supply change when the guest left at 12pm. On 03/19/2026, S1 stated that R1 was provided status checks and R1 was changed twice in the PM shift.
SUPERVISORS NAME: David Sicairos
LICENSING EVALUATOR NAME: Daniel Konishi
LICENSING EVALUATOR SIGNATURE:

DATE: 04/09/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/09/2026
LIC9099 (FAS) - (06/04)
Page: 2 of 4
Control Number 28-AS-20260320085012
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: 04/09/2026
NARRATIVE
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Based on record review, LPA reviewed Shift to Shift Report that indicated that on 03/19/2026, R1 was checked on at 5:45pm and changed at 8:45pm to 9:10pm. LPA interviewed one (1) additional staff that could not confirm nor deny the allegation since they are not involved in providing this service. Therefore, there was not enough sufficient evidence to corroborate with the allegation.

Allegation: “Due to staff neglect, resident was left in bed/clothes not changed.” It is alleged that on 03/17/2026, R1 had a diaper change but R1’s clothes were not changed until R1 asked S1 if R1’s shirt was wet in urine. At which time, S1 changed R1’s shirt. LPA interviewed R1 that denied the allegation stating that on 03/17/2026, R1 was changed by S1 and addressed no concerns. LPA interviewed five (5) residents that denied the allegation stating that their clothes are changed and not left in bed. However, LPA interviewed an additional four (4) residents that could not confirm nor deny the allegation stating that they do not require any incontinence supplies change from the staff. LPA interviewed the Administrator, and two (2) staff that on 03/17/2026, S1 and S2 went to R1’s room but R1 was with a guest until 12pm. However, S1 and S2 continued to conduct status checks every two hours and S1 and S2 continued to refuse clothes changes until the guest left at 12pm. Therefore, there was not enough sufficient evidence to corroborate with the allegation.

Allegation: “Staff did not ensure residents air conditioner was working properly.” It is alleged that on 03/17/2026, R1’s air conditioning was not working properly so R1 was under warm blankets until 12:15pm. LPA interviewed the Administrator, and three (3) out of three (3) staff that denied the allegation stating that on 03/17/2026, the air conditioner is working in R1’s room and the entire facility. Based on record review, LPA reviewed facility’s HVAC service order invoice dated 02/26/2026 which indicated that all Air Conditioning systems are working and filters were deep cleaned. LPA interviewed R1 and 10 (ten) residents that denied the allegation stating that the facility’s air conditioning system was working on 03/17/2026. One (1) staff stated that due to the warm weather, the facility’s air conditioner makes the facility much cooler so facility staff provide blankets to staff for any residents that requests blankets. There was not enough sufficient evidence to corroborate with the allegation.

[Continue to LIC9099-C]
SUPERVISORS NAME: David Sicairos
LICENSING EVALUATOR NAME: Daniel Konishi
LICENSING EVALUATOR SIGNATURE:

DATE: 04/09/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/09/2026
LIC9099 (FAS) - (06/04)
Page: 3 of 4
Control Number 28-AS-20260320085012
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: 04/09/2026
NARRATIVE
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Allegation: “Due to staff neglect, resident was not fed breakfast.” It is alleged that on 03/17/2026, R1 was not provided breakfast. LPA interviewed R1 that denied the allegation stating that R1 received breakfast delivered from staff on 3/17/2026. R1 also stated that the staff continue to provide breakfast and helps feeding R1 at 9am daily. R1 had no further concerns regarding staff serving breakfast. LPA interviewed two (2) residents that denied the allegation stating that they received breakfast delivered to their bedroom on 3/17/2026. LPA interviewed eight (8) residents that could not confirm nor deny the allegation since they go to the dining room for all meals on a daily basis. However, the eight (8) residents stated that breakfast is provided at the dining room on a daily basis. LPA interviewed administrator, and two (2) out of three (3) staff denied the allegation stating that on 3/17/2026, R1 declined receiving breakfast when S1 and S2 went to R1’s room at 8:15am. S1 and S2 stated that S1 and S2 both continued to visit R1’s room but R1 continued to decline breakfast on that day. One (1) staff stated that grilled cheese sandwiches for lunch was provided to R1 on 03/17/2026. The Administrator and two (2) staff stated that breakfast is provided and feeding assistance to R1 at 9am daily. There is not enough evidence to substantiate.

Based on statements and interviews conducted with staff, residents, review of resident 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 was held, and a copy of this report was provided to the Administrator, Bryanna Luke.

SUPERVISORS NAME: David Sicairos
LICENSING EVALUATOR NAME: Daniel Konishi
LICENSING EVALUATOR SIGNATURE:

DATE: 04/09/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/09/2026
LIC9099 (FAS) - (06/04)
Page: 4 of 4