198603566-5-13-2025-28-AS-WSHO-DGQKNF-20250516080302

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198603566
Report Date: 05/13/2025
Date Signed: 05/13/2025 01:30:45 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
05/05/2025 and conducted by Evaluator Mary G Flores

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20250505162357

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: 147	DATE:	05/13/2025
		UNANNOUNCED	TIME BEGAN:	09:00 AM
MET WITH:	Stephanie Funderburg - Administrator		TIME COMPLETED:	01:45 PM

ALLEGATION(S):

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Facility staff do not ensure resident eats an adequate amount of food

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 Stephanie Funderburg and explained the reason for the visit.

The investigation consisted of the following: LPA requested copies of staff/resident roster. LPA reviewed file for resident #1 (R1) and request copies of physician’s report, identification and emergency information sheet, needs and care plan, pre-placement appraisal, chart notes, physician’s visit records, medical discharge records. LPA interviewed 10 residents and 8 staff.

The investigation revealed the following: Regarding allegation: Facility staff do not ensure resident eats an adequate amount of food. It is alleged R1 is malnourished with muscle waste due to neglect. Interviews with residents revealed 9 out of 10 residents stated meals with plenty of food is provided to them daily. Per residents, they receive three meals a day and they are given options if they don’t like the food.
(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: 05/13/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/13/2025

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-20250505162357

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: 05/13/2025

NARRATIVE

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One out of ten (1 out of 10) residents was unable to answer interview due to cognitive skills. Interviews with staff revealed residents are encouraged to eat their meals and assisted when needed. Per staff, if changes in condition are noticed they are noted in the resident chart notes. Medication Technician then follow up with physician and/or family members. Administrator stated staff did observed R1’s food intake decreased. However, R1’s physician was conducting visit. On 5/2/25, R1’s physician recommended nutritional shake to be increase. Documents reviewed revealed R1’s physician’s report dated: 1/2/25 notes, R1 has a special diet due to health condition. R1’s service plan dated: 3/5/25 notes R1 will obtain assistance with cutting and preparing food or prompting throughout the meal. Medical evaluation conducted on 2/24/25 notes R1 is consuming three meals a day. Facility’s notes from 4/7/25 – 5/12/25 note R1 refused to eat on 4/7/25, 4/18/25, 5/3/25. Physician visited R1 on 3/20/25, 4/23/25,5/2/25. Physician’s order dated: 5/2/25 note an increase from 1 to 3 nutrition shakes a day for R1. Although R1 did seem to have had a change in condition. Per interviews conducted facility staff have assisted R1 with food intake and physician’s follow ups/visits. Therefore, this allegation is unsubstantiated.

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 Administrator 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: 05/13/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/13/2025

LIC9099 (FAS) - (06/04)

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