198603566-3-26-2026-28-AS-LHIS-DTBPJB-20260420112117

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198603566
Report Date: 03/26/2026
Date Signed: 03/26/2026 05:23:14 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
12/17/2025 and conducted by Evaluator Bennette Pena

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20251217104411

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:	09:33 AM
MET WITH:	Maria Quizon - Executive Director		TIME COMPLETED:	05:30 PM

ALLEGATION(S):

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Staff do not ensure prescribed medications are properly managed or dispensed.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Bennette Pena conducted an unannounced subsequent complaint investigation visit regarding the above stated allegation. LPA met with Margaret ‘Maggie’ Jay, Business Office Manager and explained the reason for the visit. Shortly after, Maria Quizon Executive Director met with LPA and assisted with the investigation.

The investigation consisted of the following: On 12/24/2025, LPA Madyun obtained copies of staff/resident roster and reviewed files for fifteen (15) residents such as Physician reports, admission agreements, appraisal needs and services plans, identification and emergency information, face sheets, and medication sheets for June and December 2025. LPA Madyun also conducted interviews with Staff #1 (S1) - Staff #3 (S3).

During today’s visit, LPA Pena conducted a tour of the facility focusing on the medication room, obtained copies of the staff & resident rosters, Resident #1 (R1) and random staff/Med Tech files files pertinent to the investigation and facility's medication policy. LPA re-interviewed S1, interviewed Staff #4 (S4) - Staff #5 (S5), Resident #1 (R1) - Resident #6 (R6) and telephonically interviewed Staff #6 (S6) *****CONTINUED ON LIC9099-C*****

Substantiated

Estimated Days of Completion:

SUPERVISORS NAME: Lisa Hicks
LICENSING EVALUATOR NAME: Bennette Pena
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 5

Control Number 28-AS-20251217104411

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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The investigation revealed the following:

Regarding the allegation: "Staff do not ensure prescribed medications are properly managed or dispensed." It was alleged that staff do not dispense all of R1's medications and the pain medication is consistently missing. (2) out of (6) staff interviewed corroborated the allegation. Staff stated that they observed many medication errors on their shifts and many residents are aware that they were not getting all of their medications. (2) staff also stated that they have seen other staff pre-pour all the medication the night before, as directed and postpone giving it to the residents. When it's too late, staff would simply throw away the medication, causing the residents to miss their scheduled medication regimen. (2) of (6) residents interviewed stated that the staff had either forgotten to administer their medications on time or had failed to administer their medications at all. LPA observed a number of medication errors for (4) different residents including R1. Additionally, a review of R1's medication administration records revealed that procedures were not followed and there was insufficient supervision. Therefore, there was sufficient evidence to corroborate with the allegation.

Based on LPA’s observations, interviews, and record reviews, the preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED.

Deficiency cited on the attached LIC 9099D. A civil penalty assessment (LIC421M) was also issued for repeat violations.

An exit interview was conducted, and a copy of this report provided to Maria Quizon, Executive Director along with the Appeal Rights.

SUPERVISORS NAME: Lisa Hicks
LICENSING EVALUATOR NAME: Bennette Pena
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 5

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
12/17/2025 and conducted by Evaluator Bennette Pena

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20251217104411

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:	09:33 AM
MET WITH:	Maria Quizon - Executive Director		TIME COMPLETED:	05:30 PM

ALLEGATION(S):

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Staff does not ensure issues of missing medications is being properly addressed.

INVESTIGATION FINDINGS:

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Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Lisa Hicks
LICENSING EVALUATOR NAME: Bennette Pena
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: 3 of 5

Control Number 28-AS-20251217104411

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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The investigation revealed the following:

Regarding the allegation: "Staff does not ensure issues of missing medications is being properly addressed." It was alleged that R1 has been consistently missing a prescribed medication and facility's pharmacy has regularly failed to fulfill R1's prescription in a timely manner. Staff interviewed stated that R1 did not have missing medications but has a PRN prescription that cannot be filled early without a doctor's intervention. R1 has a PRN prescription for (120) pills, supposedly good for (4) months. However, the pills only lasted for thirty days because R1 took the medication four times daily. Because it is a controlled substance and not on cycle, it needed doctors authorization. When staff contacted the pharmacy to follow up, the pharmacy claimed they have not received the authorization from R1's doctor yet. Staff stated that their method in requesting refills for medication from PAX pharmacy is either via fax, phone or online and the pharmacy is quick with response time and completing orders. Interviewed residents stated that they have not missed medications and they get refills on time. Documents reviewed showed that staff have followed the method for refilling the medication but there may have been a breakdown in communication between the physician and/or the pharmacy. Therefore, there was insufficient evidence to corroborate with the allegation.

Based on statements and interviews conducted with residents and staff as well as reviewed files and documentation, there was not enough supportive evidence to corroborate the allegation.

Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is UNSUBSTANTIATED.

Exit interview conducted and a copy of this report was provided to Maria Quizon, Executive Director.

SUPERVISORS NAME: Lisa Hicks
LICENSING EVALUATOR NAME: Bennette Pena
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 5

Control Number 28-AS-20251217104411

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(a)(4)	1 2 3 4 5 6 7	87465 Incidental Medical and Dental Care (a) A plan for incidental medical and dental care shall be developed by each facility. The plan shall encourage routine medical and dental care and provide for assistance in obtaining such care, by compliance with the following: (4) The licensee shall assist residents with self-administered medications as needed. This deficiency was evidenced by the following:	1 2 3 4 5 6 7	The licensee shall ensure all medications are administered timely and that residents do not miss any dosage. An in-service training course for medication staff shall be conducted and the log to be submitted to LPA by POC due date.
	8 9 10 11 12 13 14	Based on interview and record review, staff do not dispense all of R1's medications and R1’s medication Gabapentin 300 mg capsule was marked administered, but the medications were still on the bubble pack and the PRN pain medication was not given as prescribed which poses an immediate health and safety risk to residents in care.	8 9 10 11 12 13 14
	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: Lisa Hicks
LICENSING EVALUATOR NAME: Bennette Pena
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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