198603566-9-2-2025-28-AS-WSHO-DNLSXL-20251120131606

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198603566
Report Date: 09/02/2025
Date Signed: 09/02/2025 01:18:07 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
08/26/2025 and conducted by Evaluator Mary G Flores

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20250826094641

FACILITY NAME:	ASTORIA PARK SENIOR LIVING		FACILITY NUMBER:	198603566
ADMINISTRATOR:	STEPHANIE FUNDERBURG		FACILITY TYPE:	740
ADDRESS:	925 EAST VILLA STREET		TELEPHONE:	(626) 796-4303
CITY:	PASADENA	STATE: CA	ZIP CODE:	91106
CAPACITY:	220	CENSUS: 152	DATE:	09/02/2025
		UNANNOUNCED	TIME BEGAN:	09:06 AM
MET WITH:	Michelle Castillo - Business Office Manager		TIME COMPLETED:	01:32 PM

ALLEGATION(S):

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Facility staff did not provide medications as prescribed
Facility staff failed to provide assistance with activities of daily living
Facility staff retaliated against a resident

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Mary Flores conducted an unannounced complaint investigation visit regarding the above allegation. LPA met with Michelle Castillo and explained the reason for the visit. Administrator arrived shortly after.

The investigation consisted of the following: LPA requested a copy of staff/resident roster. LPA conducted a medication check for 8 residents, interviewed 8 residents and 6 staff, and requested copies of medication sheets for 8 residents, physician’s report, needs and care plan, and notes for resident #3 and #8(R3 and R8).

The investigation revealed the following: Regarding allegation: Facility staff did not provide medications as prescribed. It is alleged staff have not provided resident with routine medication for several occasions.

(CONTINUED ON LIC 9099C)

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Wei Siew Ho
LICENSING EVALUATOR NAME: Mary G Flores
LICENSING EVALUATOR SIGNATURE:	DATE: 09/02/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/02/2025

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-20250826094641

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: ASTORIA PARK SENIOR LIVING	FACILITY NUMBER: 198603566
	VISIT DATE: 09/02/2025

NARRATIVE

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Interviews with residents revealed 8 out of 8 residents stated they are being provided with their medications by Medication Technicians. 1 out of the 8 residents stated to have refused the medication in the evening but has been asked by med techs to take. Interviews with staff revealed medication is provided to the residents by the med-techs and it is only not provided when the resident refuses which is noted in their notes. Also the only other time a resident does not received medication is if the medication is not available due to the pharmacy not providing it. Medication review revealed medications are available for the residents, med-techs check mark their data system after providing the medication and are able to note if the resident refuses medication in the data system. Resident’s notes revealed the resident in question refused medication on two occasions.
Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegation is UNSUBSTANTIATED.

Regarding allegation: Facility staff failed to provide assistance with activities of daily living. It is alleged staff did not provided resident with showers as schedule. Interviews with residents revealed 4 out of 8 residents do not need assistance with showers. However, staff assist them with other activities of daily living as needed. 4 out of 8 residents who require assistance with showers said they have received their showers as scheduled. However, 1 of the 4 residents, stated that they have requested a bed bath instead to an agency employee and not a facility staff, and was deny the request. Interviews with staff revealed residents are assisted with showers twice a week. Some residents are provided showers three times a week. Per staff, if a resident refuses a shower they are asked at least 3 times during that shift. If they continue to refuse, it is noted with the med-tech that they refused. If the residents request a shower on a different day, staff will provide the shower if they are available. Per documents reviewed resident in question needs full assistance with showers and are noted twice a week, no notes of shower refusal were observed.
Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegation is UNSUBSTANTIATED.

Regarding allegation: Facility staff retaliated against a resident. It is alleged staff retaliated against the resident by not assisting with showers due to resident not wanting to use the Hoyer lift. Interviews conducted with residents revealed 8 out of 8 residents stated staff have not responded in a retaliated manner in any situation. Per residents, staff are nice and assist as needed. Interviews with staff revealed, upon a resident refusing to shower. The staff communicate to the residents that if they are not showered the day of the scheduled shower, they may need to wait until the next schedule shower. However, they do make an effort to provide a shower if the resident had previously refused upon the residents’ request and staff have the availability during their shift. Per staff they will not respond to the resident in a retaliated manner.
Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegation is UNSUBSTANTIATED.

SUPERVISORS NAME: Wei Siew Ho
LICENSING EVALUATOR NAME: Mary G Flores
LICENSING EVALUATOR SIGNATURE:	DATE: 09/02/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/02/2025

LIC9099 (FAS) - (06/04)

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Control Number 28-AS-20250826094641

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: ASTORIA PARK SENIOR LIVING	FACILITY NUMBER: 198603566
	VISIT DATE: 09/02/2025

NARRATIVE

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The staff communicate to the residents that if they are not showered the day of the scheduled shower, they may need to wait until the next schedule shower. However, they do make an effort to provide a shower if the resident had previously refused upon the residents’ request and staff have the availability during their shift. Per staff they will not respond to the resident in a retaliated manner.

Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegation is UNSUBSTANTIATED.

Exit interview was conducted with Stephanie Funderburg and a copy of this report was provided.

SUPERVISORS NAME: Wei Siew Ho
LICENSING EVALUATOR NAME: Mary G Flores
LICENSING EVALUATOR SIGNATURE:	DATE: 09/02/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/02/2025

LIC9099 (FAS) - (06/04)

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