198603295-4-23-2026-28-AS-DSIS-DTJT4W-20260427142438

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198603295
Report Date: 04/23/2026
Date Signed: 04/23/2026 12:38:58 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
12/05/2025 and conducted by Evaluator Daniel Konishi

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20251205112306

FACILITY NAME:	PASA ALTA MANOR		FACILITY NUMBER:	198603295
ADMINISTRATOR:	CHERTOK, VLADIMIR		FACILITY TYPE:	735
ADDRESS:	1790 N FAIR OAKS AVENUE		TELEPHONE:	(626) 798-6986
CITY:	PASADENA	STATE: CA	ZIP CODE:	91103
CAPACITY:	90	CENSUS: 82	DATE:	04/23/2026
		UNANNOUNCED	TIME BEGAN:	12:28 PM
MET WITH:	Estefany Lopez, Administrator		TIME COMPLETED:	12:45 PM

ALLEGATION(S):

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Staff do not prevent residents from using illegal drugs

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Daniel Konishi conducted a subsequent complaint visit to deliver findings regarding the above allegations. LPA met with Administrator Estefany Lopez and discussed the purpose of the visit.

On 12/08/2025, the initial investigation visit was conducted. The investigation consisted of the following:
Review of Client#1 (C1) to Client #3 (C3’s) file and a physical plant tour of the facility. The following documents pertaining to C1, C2, and C3 were requested and the Administrator will send to the LPA by the COB: Face Sheet, Admission Agreement, Physician’s Report, House Rules, Appraisal/Needs and Services Plan, Centrally Stored Medication Record/Medication Administration Records (November 2025 and December 2025), Physician’s Order, Illegal Drug Policy, and special incident reports. LPA also requested the staff and client roster which the Administrator will send to the LPA by COB. No health and safety concerns were observed.

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: David Sicairos
LICENSING EVALUATOR NAME: Daniel Konishi
LICENSING EVALUATOR SIGNATURE:	DATE: 04/23/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/23/2026

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

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Control Number 28-AS-20251205112306

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: PASA ALTA MANOR	FACILITY NUMBER: 198603295
	VISIT DATE: 04/23/2026

NARRATIVE

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During today's visit the investigation revealed the following: in regard to the allegation, “Staff do not prevent residents from using illegal drugs.” It is alleged that residents are doing illegal drugs at the facility. It is also alleged that C1 is doing methamphetamine in C1’s room and other residents are also doing methamphetamine. This allegation was investigated by the Investigation Bureau (IB) and was assigned to Investigator Santana. LPA reviewed IB interviews which revealed the following: The facility conducts random drug tests when there is suspicion of drug use. C1 moved into the facility on 12/06/2024 with a known history of substance use that was being addressed by outside case managers. When one such case manager notified the facility on 1/26/2025 about concerns that C1 was smoking methamphetamine in C1’s facility room, the facility had C1 perform a urine drug test. Although the drug test appears to show a positive result for methamphetamine, the facility contends it is negative. This investigation found no evidence that the facility reported this drug use allegation to C1’s psychiatrist at that time, which the facility would normally do for such a concern, but the case manager was aware of it and addressed it through C1’s outside program. C1 tested positive for methamphetamine at the program in July and October 2025, but it appears the program did not report these results to the facility, so the facility was unaware. However, because the facility noted a change in C1’s behavior, it did notify this change in condition to C1’s psychiatrist, which the psychiatrist confirmed. Although the Administrator believes the facility should have drug tested C1, and followed up with the case managers, more frequently, this investigation cannot conclude that the facility did not make efforts to address C1’s drug use. Therefore, there is not enough evidence to substantiate.

Based on statements and interviews conducted with staff, clients, review of client 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, Estefany Lopez.

SUPERVISORS NAME: David Sicairos
LICENSING EVALUATOR NAME: Daniel Konishi
LICENSING EVALUATOR SIGNATURE:	DATE: 04/23/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/23/2026

LIC9099 (FAS) - (06/04)

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