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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198603566
Report Date: 08/08/2025
Date Signed: 08/08/2025 02:07:17 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
08/03/2025 and conducted by Evaluator Kimberly Ramirez
PUBLIC
COMPLAINT CONTROL NUMBER: 28-AS-20250803223816
FACILITY NAME:ASTORIA PARK SENIOR LIVINGFACILITY NUMBER:
198603566
ADMINISTRATOR:STEPHANIE FUNDERBURGFACILITY TYPE:
740
ADDRESS:925 EAST VILLA STREETTELEPHONE:
(626) 796-4303
CITY:PASADENASTATE: CAZIP CODE:
91106
CAPACITY:220CENSUS: 151DATE:
08/08/2025
UNANNOUNCEDTIME BEGAN:
08:17 AM
MET WITH:Administrator Stephanie FunderburgTIME COMPLETED:
02:45 PM
ALLEGATION(S):
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Staff prohibit resident from leaving the facility.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Kimberly Ramirez conducted an unannounced initial complaint investigation visit on 08/08/2025, regarding the above allegation. LPA Ramirez identified herself and was greeted by the Wellness Director- Ruth Villa and explained the purpose of the visit. Administrator Stephanie Funderburg arrived shortly after to assist with tour.

The investigation consisted of the following: LPA Ramirez requested and obtained copies of Resident/Client Roster, Staff roster, Staff#1 – 4, 6, interviews (S1 – S4, S6), Attempted Interview of Staff#5 (S5), Resident#1 – 6 interview (R1- R6), copies of Resident#1 (R1): physician report dated 2/10/2025, Face sheet, Service plan, Admissions Agreement, Facility Activities Schedule for the month of August 2025 & July 2025, and physical plant tour.

See 9099-C for continued narrative.
Unsubstantiated
Estimated Days of Completion:
NAME OF LICENSING PROGRAM MANAGER: Fernando Fierros
NAME OF LICENSING PROGRAM ANALYST: Kimberly Ramirez
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 08/08/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/08/2025
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-20250803223816
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: 08/08/2025
NARRATIVE
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The investigation revealed the following: regarding the allegation “Staff prohibit resident from leaving the facility.” It is alleged staff prohibit resident#1 (R1) from leaving the facility. LPA Ramirez reviewed and obtained a copy of R1’s physician’s report, which revealed that R1 may not leave the facility unassisted. Interview with resident#1 (R1) revealed that R1 enjoys going on outings when R1 chooses to sign up for an outing. Five (5) out of the five (5) staff interviewed denied the allegation. Five (5) out of the six (6) residents interviewed denied the allegation. Interview with Staff#1 (S1) revealed that R1 may not leave the facility unassisted however, the facility offers in-house activities and community outings. S1 revealed residents can sign up for community outings if they choose to do so. LPA Ramirez reviewed and obtained a copy of the facility posted Activities Schedule for the months of August 2025 and July 2025. LPA Ramirez observed several community outings listed including, mornings walks, outings to museums, local ice cream parlors, local restaurants, local retail stores and local movie theaters. 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.

No deficiencies were cited. Exit interview was conducted. A copy of this report was provided via email.

NAME OF LICENSING PROGRAM MANAGER: Fernando Fierros
NAME OF LICENSING PROGRAM ANALYST: Kimberly Ramirez
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 08/08/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/08/2025
LIC9099 (FAS) - (06/04)
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