198603566-3-26-2026-28-AS-RORN-DSWVBX-20260407161816

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198603566
Report Date: 03/26/2026
Date Signed: 03/26/2026 05:37:16 PM

Substantiated

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
03/23/2026 and conducted by Evaluator Bonnie Tao

COMPLAINT CONTROL NUMBER: 28-AS-20260323135810

FACILITY NAME:	ASTORIA PARK SENIOR LIVING		FACILITY NUMBER:	198603566
ADMINISTRATOR:	MARIA QUIZON		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:	08:00 AM
MET WITH:	Administrator Maria Quizon		TIME COMPLETED:	12:00 PM

ALLEGATION(S):

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Staff is mismanaging resident's medications.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Tao conducted an unannounced 10-day complaint visit to this facility. Upon arriving at the facility, LPA met with Maria Teresita Capito Quizon, administrator. LPA explained the purpose of today’s visit and discussed the allegation mentioned above to administrator Maria Quizon.

The investigation consisted of resident / staff interviews and medication/ facility records reviews. LPA obtained resident roster, staff roster, resident’s medication records and residents’ facility files.

The investigation revealed the following:

In regards of facility staff is mismanaging resident's medications, it is alleged that staff did not administer medication to residents as prescribed. Per resident interviews, LPA attempted but unable to interview resident#1 (R1) because resident was out in the community with family.
(-Continued on LIC 9099-)

Substantiated

Estimated Days of Completion:

SUPERVISORS NAME: Fernando Fierros
LICENSING EVALUATOR NAME: Bonnie Tao
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)

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Control Number 28-AS-20260323135810

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: 03/26/2026

NARRATIVE

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Per resident interview from resident #2 (R2) to resident #4 (R4), two (2) out of three (3) residents interviewed stated that they were not aware of any missing medication. One (1) out of three (3) residents interviewed stated the resident’s medication was missing a pill or two pills occasionally. It revealed most residents were not aware of any missing medication. Per staff interviews with the administrator and med tech, they were aware of mismanagement of residents’ medication in the facility. Administrator and Human Resource were involved to investigate the incident. As a result, a med tech was suspended due to mismanage residents’ medication. LPA reviewed residents’ medication and medical records from resident #5 (R5) to resident #7 (R7) with Med Tech. Medication mismanagement was observed as the following. A medication log of a resident was not updated which a discontinued medication was still on the list. A discontinued medication was still administered to a resident while the medication was discontinued. Med tech immediately removed such medication from the resident’s medication during the review. In addition, a resident’s controlled medication log and the bubble pack showed such controlled medication was administered twice on 03/14/26 but did not administer on 03/18/26. Therefore, facility staff is mismanaging resident's medications.

Based on record review and interviews conducted, the preponderance of evidence standard has been met, therefore the above allegations are found to be SUBSTANTIATED. Deficiencies are being cited according to California Code of Regulations, Title 22 and Health and Safety Code.

An exit interview was conducted with Administrator. A copy of this report and appeal rights were provided.

SUPERVISORS NAME: Fernando Fierros
LICENSING EVALUATOR NAME: Bonnie Tao
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)

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Control Number 28-AS-20260323135810

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
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 03/26/2026

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type A 03/27/2026 Section Cited CCR 87465(h)(6)	1 2 3 4 5 6 7	(h) The following requirements shall apply to medications which are centrally stored:..(6)The licensee shall be responsible for assuring that a record of centrally stored prescription medications for each resident is maintained. This requirement is not met as evidenced by: Per medication review,	1 2 3 4 5 6 7	Licensee agreed to (1) review all residents' medication and medication log to ensure residents' medications are current. (2) provide additional medication administration / in service training to all staff and provide proof to the department; (3) review Title 22, Section 87465 and provide a signed statement
	8 9 10 11 12 13 14	R5 TK has control Rx Pregabalin 150 mg adminsitered twice on 3/14/26 but did not administer on 3/18/26. R6 AT has discontinued Rx-Midodrine HCL 2.5 MG still given to R6 on 3/26/26. R7 SS, has discontinued Rx-Furosemide 40 mg no longer administered but still listed on MAR. Licensee did not have an explanation about Rx discrepancy/ record.Based on observation and record review, the licensee did not comply with the section cited above which poses an immediate health, safety or personal rights risk to persons in care.	8 9 10 11 12 13 14	indicating the review of this section detailing how to prevent future medication errors by the POC date.
	1 2 3 4 5 6 7		1 2 3 4 5 6 7
	1 2 3 4 5 6 7		1 2 3 4 5 6 7

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: Fernando Fierros
LICENSING EVALUATOR NAME: Bonnie Tao
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)

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