198603566-5-20-2025-28-AS-FFIS-DHJNS5-20250611104235

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198603566
Report Date: 05/20/2025
Date Signed: 05/20/2025 06:10:39 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
04/14/2025 and conducted by Evaluator Cynthia D Chan

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20250414163448

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:	05/20/2025
		UNANNOUNCED	TIME BEGAN:	09:00 AM
MET WITH:	Stephanie Funderburg, Administrator		TIME COMPLETED:	01:00 PM

ALLEGATION(S):

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Resident was physically/mentally abused while in care.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Cynthia Chan conducted a subsequent complaint investigation regarding the allegation listed above. LPA met with Administrator, Stephanie Funderburg, and explained the purpose of the visit.

On 4/22/25, LPA toured the facility and obtained copies of the resident roster, staff roster, and documents for Resident #1. Interviews were held with the administrator, Staff #1 - #6, and 4 Residents. During today’s visit, LPA interviewed a Staff and 6 Residents.

The investigation revealed the following:
Allegation – Resident was physically/mentally abused while in care. It is alleged that the incident occurred on 3/20/25 at approximately 7 pm. Resident #1 (R1) was being physically and mentally abused by two employees.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Fernando Fierros	TELEPHONE: (323) 981-3981
LICENSING EVALUATOR NAME: Cynthia D Chan	TELEPHONE: (323) 981-3370
LICENSING EVALUATOR SIGNATURE:	DATE: 05/20/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/20/2025

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-20250414163448

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: 05/20/2025

NARRATIVE

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LPA interviewed R1 during the visit today. R1 recalled 2 staff being rough while trying to get the resident to the showers. R1 stated that one of the staff was frustrated and said to “get in the shower.” R1 did not recall the staff names and stated that it was the only time R1 had seen them working.
LPA interviewed the administrator and 7 staff, which included the agency staff who worked during the time of the incident. Staff interviewed stated they have not observed any staff physically or mentally abusing residents in care. They will report it if they see any staff being abusive or aggressive. They stated that they receive annual training on how to properly transfer residents to prevent injuries. Regarding Resident #1, they stated they did not notice any bruises on the resident’s hands or arms until the police came to investigate. R1 did not mention any abuse or roughness prior to the police visit on 4/15/25. It was reported that R1 obtained bruises to the left and right arms during a shower transfer in March 2025. Staff interviewed denied being rough with R1 during transfers and stated they would ask other staff to assist with transferring R1. According to the administrator, there were no reports of staff being rough or injuring R1 during transfers. An additional nine residents interviewed have not been hurt or injured by staff. They stated the staff are respectful and careful. They have not seen any staff abusing residents in any way.

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 allegation is UNSUBSTANTIATED.

An exit interview was conducted with the administrator. A copy of this report, along with the appeal rights, was provided.

SUPERVISOR'S NAME: Fernando Fierros	TELEPHONE: (323) 981-3981
LICENSING EVALUATOR NAME: Cynthia D Chan	TELEPHONE: (323) 981-3370
LICENSING EVALUATOR SIGNATURE:	DATE: 05/20/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/20/2025

LIC9099 (FAS) - (06/04)

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