198603566-1-7-2025-28-AS-TVAO-DCWMPH-20250114084706

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198603566
Report Date: 01/07/2025
Date Signed: 01/07/2025 03:39:20 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
GREATER LA AC/SC, 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
12/30/2024 and conducted by Evaluator Mary G Flores

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20241230155252

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: 129	DATE:	01/07/2025
		UNANNOUNCED	TIME BEGAN:	09:05 AM
MET WITH:	Michelle Castillo - Community Liason Director		TIME COMPLETED:	03:00 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Staff are not properly storing a resident's personal belongings
Staff do not ensure the residents hygiene needs are being met

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
11
12
13

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

The investigation consisted of the following: LPA requested resident and staff rosters. LPA conducted a tour of the facility and observed 10 random resident rooms. LPA interviewed 10 residents and 9 staff. LPA requested staff assignment chart and service plan for resident #1 - #2(R1-R2).

The investigation revealed the following: Regarding allegation: Staff are not properly storing a resident’s personal belongings. It is alleged boxes are being stored in resident’s shower. Per interviews conducted residents stated they have sufficient space to store their belongings. Per staff, residents’ personal belongings are stored in their closet and/or drawers. Administrator stated, R2 had boxes in the shower prior to getting a roommate. R2 was requested to move the boxes as a roommate would be moving in. (CONTINUED ON LIC 9099C)

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Tony Vasallo	TELEPHONE: (818) 419-8131
LICENSING EVALUATOR NAME: Mary G Flores	TELEPHONE: (323) 981-3965
LICENSING EVALUATOR SIGNATURE:	DATE: 01/07/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/07/2025

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 2

Control Number 28-AS-20241230155252

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
GREATER LA AC/SC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754

FACILITY NAME: ASTORIA PARK SENIOR LIVING	FACILITY NUMBER: 198603566
	VISIT DATE: 01/07/2025

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

Administrator attempted to resolve the situation by providing staff to assist R2 to store the items in the boxes and offered to purchase additional storing space for R2. However, R2 refused. During the tour of the facility LPA did not observe any personal belongings or boxes stored in the showers of each residents’ room. A closet and drawers were observed in each room assigned to each resident.

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: Staff do not ensure the resident’s hygiene needs are being met. It is alleged residents have not been assisted with showers in almost a month and their bedding is not maintain clean and free of feces. Interviews with residents revealed residents are assisted with showers and are provided a shower at least twice a week. Some residents stated that they are independent and are able to take a shower on their own and had no concerns regarding access to their personal shower. A few residents stated they rather use the common shower when necessary. Interviews with staff revealed residents are schedule to be assisted with showers twice a week. However, if a resident chooses to shower more often, they assist them as needed or if the if the staff determine the resident needs a shower for any reason, they are provided a shower more frequent. Per staff there is a large communal shower that is accessible to the residents for easiest access. Per staff schedule residents are assisted with showers. Per Service plans reviewed residents are receiving assistance with bathing “2x per week”. Per staff assignment chart residents are assisted R1 is assisted with showers on Sundays and Wednesdays and R2 is assisted with showers on Tuesdays and Thursdays. During LPAs toured beds were observed clean, free of debris, and feces.

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.

SUPERVISOR'S NAME: Tony Vasallo	TELEPHONE: (818) 419-8131
LICENSING EVALUATOR NAME: Mary G Flores	TELEPHONE: (323) 981-3965
LICENSING EVALUATOR SIGNATURE:	DATE: 01/07/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/07/2025

LIC9099 (FAS) - (06/04)

Page: 2 of 2