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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198603566
Report Date: 12/20/2025
Date Signed: 12/20/2025 11:02:14 AM

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
12/08/2025 and conducted by Evaluator Christian Gutierrez
PUBLIC
COMPLAINT CONTROL NUMBER: 28-AS-20251208151137
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:
12/20/2025
UNANNOUNCEDTIME BEGAN:
09:49 AM
MET WITH:Stasha ProvittTIME COMPLETED:
11:05 AM
ALLEGATION(S):
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Staff do not safeguard resident's personal belongings
Staff do not respond to calls from resident's representative in a timely
manner
INVESTIGATION FINDINGS:
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Licensing Program Analysts (LPA) Christian Gutierrez conducted an unannounced subsequent complaint visit in response to the above allegations. LPA met with Stasha Provitt who assisted with today’s visit.

The investigation consisted of the following: During the initial visit conducted on 12/06/2025, LPA interviewed Executive Director, Staff 1-staff 6 (S1-S6), residents 2- residents 5(R2-R5) and witness 1- witness 3 (W1-W3) by telephone. LPA obtained copies of the following documents: staff roster, resident roster, R1’s physicians reports LIC 602, Residents appraisal LIC 603, wellness group history and physical report, and emails regarding R1’s lost item. During today’s visit LPA delivered findings.

SEE LIC 9099C
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: David Sicairos
LICENSING EVALUATOR NAME: Christian Gutierrez
LICENSING EVALUATOR SIGNATURE:

DATE: 12/20/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/20/2025
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-20251208151137
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: 12/20/2025
NARRATIVE
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In regard to the allegation “Staff do not safeguard resident's personal belongings”, it is alleged that R1 was missing prescription glasses. During interviews with Administrator and staff four (4) out of seven (7) stated that R1 always takes off his/her glasses and puts them down. Staff stated that R1 needs to be remined to put on their glasses and they are always found under the bed or in the pillows. Administrator stated that although R1 may have never took of glasses before this could be a new behavior with someone with dementia. During interviews with residents two (2) out of five (5) residents stated they have never had anything missing from facility. R3 stated that they had a missing item but never reported it to staff.

In regard to the allegation “Staff do not respond to calls from resident's representative in a timely Manner”, it is alleged that facility took to long to respond to phone calls and emails about R1’s missing item. During interviews with Administrator and staff seven (7) out of seven (7) stated that they always call back family and friends in a timely manner. Administrator stated that it took three days to call representative of R1 back because that was their first day working at the facility. S4 stated that he/she took the call from the representative on Saturday and informed them that the people they were emailing were no longer with the company. S4 all stated that they personally went to look for the missing item. LPA interviewed three (3) witnesses by telephone and all three stated they have had no issues in regard to callbacks or emails from the facility. Witness #2 two stated that it might take a little longer for a caregiver to call back but that’s because they are busy with residents. LPA obtained emails from S4 to staff explaining glasses were missing and new email contacts were proved to R1’s representative.

Based on interviews conducted and records reviewed, there is insufficient evidence to support the allegations. Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are UNSUBSTANTIATED.

An exit interview was conducted, and a copy of this report was provided.

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SUPERVISORS NAME: David Sicairos
LICENSING EVALUATOR NAME: Christian Gutierrez
LICENSING EVALUATOR SIGNATURE:

DATE: 12/20/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/20/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 2