198603566-3-26-2026-28-AS-LHIS-DSRV6S-20260402161000

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198603566
Report Date: 03/26/2026
Date Signed: 03/26/2026 03:44:09 PM

Substantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 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
10/24/2025 and conducted by Evaluator Noemi Galarza

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20251024162227

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: 150	DATE:	03/26/2026
		UNANNOUNCED	TIME BEGAN:	02:01 PM
MET WITH:	Maria Quizon, Executive Director		TIME COMPLETED:	03:45 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Facility did not ensure that there is adequate staffing to meet the needs of the residents in care.
Facility is falsifying the staffing schedule.

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
11
12
13

Licensing Program Analyst (LPA) Galarza conducted an unannounced subsequent visit to continue and deliver findings on the above allegations. The purpose of the visit was explained to Executive Director Maria Quizon and new Memory Care Director Zion Brown.

The investigation consisted of: On 10/30/2025,a physical plant tour of the facility Assisted Living areas and Memory Care Unit was conducted. Staffing schedules, resident files, Memory Care incident reports [Sep 2025- to present], and Dementia Plan of Operation were reviewed. A total of 10 staff were interviewed. Copies of resident face sheets, Medical Assessments, Service Plans, staffing schedules, 16 MCU incident reports, and LIC 500 Personnel Report were obtained. During today's visit, the new Memory Care Director was interviewed, as well as Memory Care residents (R2- R10) were interviewed. Resident (R1) was not interviewed because they are deceased. A physical plant inspection of the Memory Care Unit was conducted.

*Narrative continues next page.

Substantiated

Estimated Days of Completion:

SUPERVISORS NAME: Lisa Hicks
LICENSING EVALUATOR NAME: Noemi Galarza
LICENSING EVALUATOR SIGNATURE:	DATE: 03/26/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/26/2026

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-20251024162227

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754

FACILITY NAME: ASTORIA PARK SENIOR LIVING	FACILITY NUMBER: 198603566
	VISIT DATE: 03/26/2026

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

Allegation: Facility did not ensure that there is adequate staffing to meet the needs of the residents in care. It is alleged that during Fall 2025 there was not enough staffing in the Memory Care Unit, and as a result residents were not receiving dressing and grooming assistance, and were being transported to the dining room in pajamas. According to information obtained, the Memory Care Director was made aware of the aforementioned concerns, but took approximately 2 weeks to respond to emailed concerns and messages. Additionally, it was reported that the facility is alerted at least 1 hour prior to the resident being picked up for medical appointments, and when they arrive to pick up resident (R1), they are not ready and have soiled incontinence briefs. It is alleged that it has occurred between 10 AM - 11 AM. A total of 10 staff and 9 residents were interviewed. Staff interviews revealed that the Memory Care Unit has a census of 50, and is supposed to have 4 caregivers in the morning and afternoon shifts. During the night shift there should be 2 caregivers and 1 medication technician that cover the entire building, which includes the Assisted Living wings. Staff stated that in late October 2025, there were only 3 caregivers working both the day and evening shift, and the Memory Care Unit did not have in place a Task Sheet that states which residents require incontinence care. Staff said that at that time the Memory Care Unit had a census of 50, of which 37 residents required incontinence care, while the Assisted Living wings only had 16 residents that received incontinence assistance. The majority of the staff interviewed confirmed staffing shortages has made it difficult to meet the Memory Care Unit resident's needs, for example sometimes the night shift changes the resident's incontinence briefs at 2:00 AM or earlier, and they do not get changed until the morning shift staff start. NOTE: During the initial complaint visit (10/30/25), there were only three (3) caregivers working during the morning shift. Based on interviews and observations during today's visit, the physical plant condition of the Memory Care Unit and grooming of residents appears improved. However, the staffing shortages that were occurring last Fall 2025 affected resident care in the Memory Care Unit. There is sufficient information to support the allegation.

SUPERVISORS NAME: Lisa Hicks
LICENSING EVALUATOR NAME: Noemi Galarza
LICENSING EVALUATOR SIGNATURE:	DATE: 03/26/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/26/2026

LIC9099 (FAS) - (06/04)

Page: 2 of 4

Control Number 28-AS-20251024162227

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754

FACILITY NAME: ASTORIA PARK SENIOR LIVING	FACILITY NUMBER: 198603566
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 03/26/2026

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 04/09/2026 Section Cited CCR 87625(b)(3)	1 2 3 4 5 6 7	Managed Incontinence.... the licensee shall be responsible for the following: Ensuring that incontinent residents are kept clean and dry and that the facility remains free of odors from incontinence. This requirement was not met evidenced by:	1 2 3 4 5 6 7	Executive Director agrees to conduct staff training in incontinence care, responsibilities, and Memory Care Unit facility protocols. Submit proof of staff training.
	8 9 10 11 12 13 14	Based on interviews and observation during the 10/30/25 physical plant inspection, the findings indicate R1 requires incontinence care at least every 2 hours and feces were observed on the floor, bedding, and mattress of a Memory Care Unit resident room. This posed a potential health and safety risk to the resident in care.	8 9 10 11 12 13 14
Type B 04/09/2026 Section Cited CCR 87413(a)(1)	1 2 3 4 5 6 7	Personnel - Operations. In each facility: When regular staff members are absent, there shall be coverage by personnel with qualifications adequate to perform the assigned tasks. This requirement was not met evidenced by:	1 2 3 4 5 6 7	Executive Director agreed to ensure staff schedules are updated, posted, and in instances of staff shortages shift coverage shall be implemented. Please submit a written plan of correction.
	8 9 10 11 12 13 14	Based on interviews and record review, it was revealed that in October 2025, 2 Memory Care Unit (MCU) staff were suspended, of which 1 was terminated, but both were listed in the MCU weekly staff schedule and administration staff did not ensure adequate staff coverage. This posed a potential health, safety, and personal rights risks to persons in care.	8 9 10 11 12 13 14

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

SUPERVISORS NAME: Lisa Hicks
LICENSING EVALUATOR NAME: Noemi Galarza
LICENSING EVALUATOR SIGNATURE:	DATE: 03/26/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/26/2026

LIC9099 (FAS) - (06/04)

Page: 3 of 4

Control Number 28-AS-20251024162227

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754

FACILITY NAME: ASTORIA PARK SENIOR LIVING	FACILITY NUMBER: 198603566
	VISIT DATE: 03/26/2026

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

Allegation: Facility is falsifying the staffing schedule. The complaint alleges that in October 2025, the staffing scheduled showed names of staff that were no longer working at the facility, and Administration staff did not remove staff names nor obtained staffing coverage for the Memory Care Unit. A total of 10 staff were interviewed. Staff said that in the month of October 2025, two (2) Memory Care Unit staff were placed on suspension, which resulted in a termination of employment. Additionally, a third Memory Care Unit staff was on leave, but their name still appeared on schedule. Staff stated the Memory Care Unit staff schedule was posted weekly, but was not accurate. Administration staff and the Memory Care Director denied the allegation, but acknowledged the posted staff schedule and documents provided to LPA do not reflect updated staffing changes and/or schedule because the terminated employee and suspended employee are still listed in the schedule, as well as the 3rd staff that was on leave. There is sufficient information to support the allegation.

Based on interviews conducted and record review, the preponderance of evidence standard has been met, therefore the above allegations are found to be SUBSTANTIATED. Pursuant to Title 22 California Code of Regulations, the following deficiencies were cited (refer to LIC 9099D).

Exit Interview was conducted, citations issued, appeal rights discussed, and a copy of the report was issued to Executive Director Maria Quizon.

SUPERVISORS NAME: Lisa Hicks
LICENSING EVALUATOR NAME: Noemi Galarza
LICENSING EVALUATOR SIGNATURE:	DATE: 03/26/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/26/2026

LIC9099 (FAS) - (06/04)

Page: 4 of 4