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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198603566
Report Date: 12/29/2025
Date Signed: 12/29/2025 04:18:11 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
06/26/2025 and conducted by Evaluator Luis DeLeon
PUBLIC
COMPLAINT CONTROL NUMBER: 28-AS-20250626085735
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: 150DATE:
12/29/2025
UNANNOUNCEDTIME BEGAN:
01:20 PM
MET WITH:AdministratorTIME COMPLETED:
04:30 PM
ALLEGATION(S):
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Staff provided unwashed utensils to resident in care
Staff did not attend to resident call for assistance
Staff did not keep the facility free of pests
INVESTIGATION FINDINGS:
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On today’s visit, Licensing Program Analyst (LPA) Luis De Leon conducted a subsequent complaint visit and met with Business Office Manager Michelle Castillo. LPA explained the reason for today’s visit was to deliver findings on the above allegations. LPA toured residents’ common areas and observed no health and safety risks. LPA interviewed one resident and obtained staff and resident rosters and Pendant Response Time.

During the initial visit on 7/1/2025, LPA toured the facility and obtained copies of the following documents: Staff roster, Resident roster, R1’s physicians reports, resident assessments, admission agreement, face sheet, facility maintenance work orders, pest control invoices, and operation plan for call response and kitchen sanitation. LPA interviewed eleven (10) residents and seven (7) staff.

Report continues on page LIC-9099C...
Unsubstantiated
Estimated Days of Completion: 90
SUPERVISORS NAME: Fernando Fierros
LICENSING EVALUATOR NAME: Luis DeLeon
LICENSING EVALUATOR SIGNATURE:

DATE: 12/29/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/29/2025
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 3
Control Number 28-AS-20250626085735
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: 12/29/2025
NARRATIVE
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Regarding allegation: Staff provided unwashed utensils to resident in care. It is alleged that the staff does not follow proper cleaning procedures for utensils used by resident in the dining room area. Investigation consisted of interview with staff, residents, and LPA observations. LPA interview with residents revealed that ten (10) out eleven (11) residents denied the allegation above. Residents stated that residents have not seen or heard of utensils to be dirty or unwashed. Residents stated that facility is clean and staff do a great job. Residents stated that staff wraps utensils in napkins to keep them clean. LPA interview with staff revealed that seven (7) out of seven (7) staff denied the allegation above. Staff stated that staff has not heard of any issues with dishwasher that would fail to clean utensils or dishes. Staff stated that sometimes residents use utensils and place utensils back on the table, but if staff notices it, the staff will remove utensils or dishes that have been used by residents. LPA observed the dish washing station while washing breakfast utensils and dishes. LPA did not observe staff failing to follow cleaning procedure for utensils and dishes. LPA observed serving stations and all utensils and dishes were clean. Based upon the investigation, residents and staff interviews, and LPA observations, there is no evidence to support that the facility staff is failing to wash utensils and dishes.

Regarding allegation: Staff did not attend to resident call for assistance. It is alleged that R1 has fallen a couple of times and staff failed to provide assistance. Investigation consisted of interview with staff, residents, and LPA observations. The investigation reveals the following: LPA interview with residents revealed that six (6) out eleven (11) residents denied the allegation above and stated that staff have responded in a timely manner or that residents have not needed to call for assistance. R8 stated that R8 used the call pendant, and the staff response was quick. Residents have observed that staff take longer to respond in the morning when staff prepares residents for grooming, showering, and escorting residents to the dining area. Eight (8) out eleven (11) residents stated that staff treats residents well and with respect. Interviews with staff reveal that seven (7) out of seven (7) staff denied the allegation. Staff denied not responding to residents call for assistance. Staff stated that the average response time is 10-15 minutes. If a caregiver is not able to respond, the med tech team assist with residents calls for assistance. Staff stated that the morning shift is more challenging for the number of residents who request assistance for preparing residents for breakfast, showering, and grooming. LPA tested the call system on four residents rooms. LPA observed that staff responded within the average response time in three (3) out of four (4) calls for assistance. Based upon the investigation, residents and staff interviews, and LPA observations, there is no evidence to support that the facility staff is not attending residents call for assistance.

Report continues on page LIC-9099C...

SUPERVISORS NAME: Fernando Fierros
LICENSING EVALUATOR NAME: Luis DeLeon
LICENSING EVALUATOR SIGNATURE:

DATE: 12/29/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/29/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 28-AS-20250626085735
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: 12/29/2025
NARRATIVE
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Regarding allegation: Staff did not keep the facility free of pests. It is alleged that the facility does not maintain facility clean free of bugs such as fleas. Investigation consisted of interview with staff, residents, facility work order logs for the period of 04/6/2025 thru 07/01/2025, Pest control invoices, and LPA observations. The investigation reveals the following: The facility work order logs records four instances, in three different residents’ room, where residents requested for bug spray in their rooms for flies. Pest control invoices revealed that the pest control treatments are done once a month. LPA interview with residents revealed that eight (8) out eleven (11) residents denied the allegation above and stated that they have not seen or heard of any pest in residents’ rooms including roaches, fleas, or flies. R1 and R5 stated that residents had seen gnats come in through the window, but if reported, staff will spray quickly. Interviews with staff reveal that seven (7) out of seven (7) staff denied the allegation. Staff denied knowing that the facility has issues with pest. Staff described issues with flies in rooms due to residents bringing fruit to residents’ rooms. Staff described water bug or roaches in patio drains but pest control is immediately contacted to treat the area. Staff denied hearing any issues with fleas. LPA did not observe any pests in residents rooms and common areas in the facility. Based upon the investigation, residents and staff interviews, document reviews, and LPA observations, there is no evidence to support that the facility staff is not maintaining the facility free of pests.

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 held with Executive Director Maria Quizon. A copy of the report was provided.

SUPERVISORS NAME: Fernando Fierros
LICENSING EVALUATOR NAME: Luis DeLeon
LICENSING EVALUATOR SIGNATURE:

DATE: 12/29/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/29/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 3