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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198603566
Report Date: 12/13/2025
Date Signed: 12/13/2025 04:01:05 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
12/10/2025 and conducted by Evaluator Tena Herrera
PUBLIC
COMPLAINT CONTROL NUMBER: 28-AS-20251210121051
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: 147DATE:
12/13/2025
UNANNOUNCEDTIME BEGAN:
01:30 PM
MET WITH:Stasha Provitt - Community Laison DirectorTIME COMPLETED:
04:15 PM
ALLEGATION(S):
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Staff did not keep facility free of insects.
Staff overcharged a resident in care.
Staff did not seek timely medical attention for resident in care.
Staff refused to assist resident in care with their insurance application.
Staff did not provide good quality foods to residents in care.
Staff did not provide proper housekeeping services to residents in care.
Staff did not treat resident with respect.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Tena Herrera conducted an unannounced subsequent complaint visit to deliever findings on the above allegations. LPA met with Stasha Provitt and discussed the purpose of the visit.

The investigation consisted of the following:

On 12/12/25 LPA conducted an intital 10day visit and obtained copies of staff/resident rosters, copy of food menu and alternate menu, copies of the following documents from R1's file: admission agreement, insurance information, payment history. LPA toured facility, kitchen, dining, and random rooms were inspected, and LPA conducted interviews with 6 Staff and 11 Residents.
During todays visit 12/13/25 LPA typed report with findings and delivered findings for the reported allegations.
(Continued on the LIC9099-C page)
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: David Sicairos
LICENSING EVALUATOR NAME: Tena Herrera
LICENSING EVALUATOR SIGNATURE:

DATE: 12/13/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/13/2025
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 4
Control Number 28-AS-20251210121051
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: 12/13/2025
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The investigation revealed the following:
Allegation: Staff did not keep facility free of insects.
It is alleged that the facility has a roach infestation. LPA toured facility, the kitchen/dining, 1st floor and 2nd floor, and a total of 8 resident rooms were inspected and LPA did not observe any insects or roaches throughout the facility. LPA interviewed 6 staff and each denied the allegation, interview with S1 revealed that there is a monthly pest control that inspects and services the facility and there have been no observations of any insects or bugs at the facility. LPA interviewed 11 residents and 9 out of 11 residents denied the allegation and stated that they have not observed roaches anywhere in the facility or their rooms.

Allegation: Staff overcharged a resident in care.


It is alleged that R1 was accused of not paying rent and forced to pay their rent twice to avoid eviction. LPA reviewed R1’s file and observed that R1 is set up on an auto withdrawal and month of July 2025 was skipped but paid in August 2025, therefore, the month of August had 2 charges. LPA interviewed 6 staff and each denied the allegation, interview with S1 revealed that there was an error in the month of July 2025 where several residents including R1 did not get charged, during an audit in August the error was discovered and residents were informed and each (including R1) agreed to pay in the month of August. S1 stated since that error was found their procedure for auto payments have changed to where now instead of staff manually inputting the information to authorize the withdrawal each month, those on auto pay are now electronically on a payment plan where funds will be withdrawn automatically with no need of staff manually processing payments. LPA interviewed 11 residents and 10 of the 11 residents denied the allegation and stated that they have not had any issues with their rent and have never been over charged.

Allegation: Staff did not seek timely medical attention for resident in care.


It is alleged that R1 experienced a fall last summer and had to wait hours for medical transport. LPA reviewed R1’s file and did not observe any notes indicating R1 had a fall and file revealed that R1 is independent and fully ambulatory. LPA interviewed 6 staff and each denied the allegation and stated that staff tend to residents immediately, if staff are busy assisting another resident when a call is heard another available staff will assist or that staff will assist as soon as they are done with the resident they are working with. LPA interviewed 11 residents and 10 out of 11 residents denied the allegation and stated that they have never had any issues with getting medical attention in a timely manner.

(Continued on the LIC9099-C page)

SUPERVISORS NAME: David Sicairos
LICENSING EVALUATOR NAME: Tena Herrera
LICENSING EVALUATOR SIGNATURE:

DATE: 12/13/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/13/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 4
Control Number 28-AS-20251210121051
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: 12/13/2025
NARRATIVE
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Allegation: Staff refused to assist resident in care with their insurance application.
It is alleged that S1 refused to assist R1 with getting their insurance set up. LPA reviewed R1’s file and observed that they have valid insurance, resident is self responsible and schedules their own visits. LPA interviewed 6 staff and each denied the above allegation, interviews with S1, S2 and S4 revealed that upon admission the insurance is set up and residents are assisted with being added to an assisted living waiver program that provides assistance/supplies/funds to their medical needs and without residents having insurance they would not be able to be a part of that program. Interviews with S1 and S4 revealed that although there were issues with the insurance group that R1 was originally with upon admission they did provide assistance in changing the insurance, however, the insurance company did not want to release information to staff and required R1 to be present for any and all changes in which R1’s expectation was for staff to handle all the changes. LPA interviewed 11 residents and 10 out of the 11 residents denied the allegation and stated that they have not had any issues with their insurance or the set up process and stated that the staff have been helpful with their needs.

Allegation: Staff did not provide good quality foods to residents in care.


It is alleged that the facility has poor food. LPA toured dining/kitchen and observed a sufficient supply of perishable foods and non-perishable foods, during the lunch hour LPA observed resident meal of egg salad sandwich with watermelon, some residents ordered off the alternate menu and meals such as a caeser salad and hamburgers were provided to those residents, residents were also observed to have a dessert with their lunch including Jello, ice cream or fresh fruit. LPA reviewed the food menu and alternate menu and meals match what LPA observed during visit. LPA interviewed 6 staff and each denied the allegation and stated that they think the food is good and nutritious and have not heard complaints about the food. Interview with S1 revealed that there is a resident committee and meetings that are held with the chef and residents where preferences are discussed and chef will make adjustments to accommodate those requests and preferences when possible. LPA interviewed 11 residents and 10 out of the 11 residents denied the allegation, although some stated that some of the meals are not to their liking they did share that the alternative menu is available and they are accommodated with something different than the meal of the day when they ask.

(Continued on the LIC9099-C page)

SUPERVISORS NAME: David Sicairos
LICENSING EVALUATOR NAME: Tena Herrera
LICENSING EVALUATOR SIGNATURE:

DATE: 12/13/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/13/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 4
Control Number 28-AS-20251210121051
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: 12/13/2025
NARRATIVE
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Allegation: Staff did not provide proper housekeeping services to residents in care.
It is alleged that the facility has poor house cleaning. LPA toured facility a total of 7 resident rooms were inspected as well as dining area and kitchen, LPA did not observe facility to have poor housekeeping. Housekeepers and Caregivers were observed to be cleaning and throwing away trash from residents room during tour. LPA toured R1’s room and although R1’s personal belongings did appear to be scattered the room did not appear to be dirty, beds were made, floor appeared clean and trash was empty. LPA interviewed 6 staff and each denied the above allegation and stated that house keeping is done daily with the routine work such as sweeping, taking out trash and making beds, the deep cleaning is done once weekly where housekeeping will mop, dust, clean bathroom, change linens and do laundry. LPA interviewed 11 residents and 10 of the 11 residents denied the above allegation, residents stated that the minor housekeeping is done daily and a deep cleaning is done once a week, residents also stated they don’t have issues with the housekeeping.
Allegation: Staff did not treat resident with respect.
It is alleged that S1 yelled, humiliated, embarrassed and accused R1 of kidnapping. Per interview with R1, resident stated they are being wrongly accused of taking another resident (R12) out of the facility without any approval. LPA interviewed S1 and they denied the allegation and stated that R1 went on an outing and lied to front desk staff that they had prior permission to take R12 out of the facility on an outing, when staff left to verify R1 quickly left facility with R12, S1 stated that R12 is not able to leave facility unassisted and R1 is not listed as a responsible party for R12. LPA reviewed R12’s file and did not see R1 listed as a responsible party, R12 has only family listed as a responsible party and POA. LPA also reviewed R12’s physician report dated 2/11/25 and it indicates that resident is not able to leave facility unassisted. LPA interviewed a total of 6 staff and each denied the allegation and stated they have never nor have they ever witnessed any other staff yell, humiliate, embarrass or accuse any of the residents. Interviews with S1-S2 & S5-S4, revealed that R12 is not to leave the facility unassisted and have been advised by POA that only the POA can take R12 out of the facility unless otherwise stated/approved, which they have not yet done so. LPA interviewed a total of 11 residents and each denied the allegation and stated they have never been yelled at, humiliated, embarrassed or accused of anything by staff and say staff treat them with respect.
During inspection of R1's room, LPA observed that the toilet in the private bathroom that R1 and their roommate share was not operable, LPA conducted a case management visit and issued a citation during the initial visit.
Based on statements and interviews conducted with staff, clients, review of client files and facility file records, there was not enough supportive evidence to concur with the reported allegations. Although the allegations may have happened are is valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations is UNSUBSTANTIATED. Exit interview held, and a copy of this report was provided.
SUPERVISORS NAME: David Sicairos
LICENSING EVALUATOR NAME: Tena Herrera
LICENSING EVALUATOR SIGNATURE:

DATE: 12/13/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/13/2025
LIC9099 (FAS) - (06/04)
Page: 4 of 4