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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198603566
Report Date: 03/16/2026
Date Signed: 03/16/2026 04:53:34 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
03/13/2026 and conducted by Evaluator Bonnie Tao
COMPLAINT CONTROL NUMBER: 28-AS-20260313143559
FACILITY NAME:ASTORIA PARK SENIOR LIVINGFACILITY NUMBER:
198603566
ADMINISTRATOR:MARIA QUIZONFACILITY TYPE:
740
ADDRESS:925 EAST VILLA STREETTELEPHONE:
(626) 796-4303
CITY:PASADENASTATE: CAZIP CODE:
91106
CAPACITY:220CENSUS: 150DATE:
03/16/2026
UNANNOUNCEDTIME BEGAN:
02:30 PM
MET WITH:Administrator, Maria Teresita Capito QuizonTIME COMPLETED:
05:00 PM
ALLEGATION(S):
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Staff do not ensure residents are safe from harm from other residents.
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 interviews, staff interviews, facility tours, and review of facility records. LPA obtained resident roster, staff roster and residents’ facility files.

The investigation revealed the following:

In regards of facility staff do not ensure residents are safe from harm from other residents, it was alleged that a resident was constantly hitting other residents with fists and walker. LPA interviewed four (4) residents including resident#1 (R1) who was alleged to hit other residents. All four (4) residents were using walkers or wheelchairs. (- continued on LIC 9099C-)
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Fernando Fierros
LICENSING EVALUATOR NAME: Bonnie Tao
LICENSING EVALUATOR SIGNATURE:

DATE: 03/15/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/15/2026
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 3
Control Number 28-AS-20260313143559
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: 03/16/2026
NARRATIVE
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Per the resident interviews, three (3) out of four (4) residents were corroborated with the allegation which resident#1 (R1) was consistently threatening to hit or had hit other residents. This situation had been going on for a year. Residents indicated other residents on the same floor with R1 would know what R1 did. LPA went to R1’s room and R1 opened the door. When LPA interviewed resident#1 (R1), the resident had the voice raised when talking to LPA at resident’s room door. Then, R1 used resident’s index finger pointing at LPA and raised voice to shout at LPA continuously. R1 moved closer to LPA with an index finger pointing at LPA’s face. R1 was about to hold a fist to LPA, LPA backed off quickly enough from being harmed and tried to de-escalate the situation. LPA thanked R1 and ended the interview. R1 slammed the door close. Per staff interviews, Administrator was aware of R1’s combative behavior. Administrator handled R1 behavior by consulting psychiatrist and changing R1’s medication for 3 times. However, no other preventive action was taken. During the facility tour, LPA observed R1 walking in the hallway with a walker. R1 was combative and had aggressive behaviors toward other people on the hallway. Therefore, staff failed to ensure residents were safe from harm from other residents.

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: 03/16/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/16/2026
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 28-AS-20260313143559
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: 03/16/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Deficiency Dismissed
Type B
04/03/2026
Section Cited
CCR
87464(f)(2)
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(2) Safe and healthful living accommodations and services.

This requirement was not met as evidenced by:
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Licensee agreed to work with R1's physician and family member for an updated care plan, change of medication and possible for a new placement for the level of care that R1 needs. Administrator will provide training for all staff in the facility related to handle resident with combative behavior. Licensee will send the
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Per LPA's in person interview with R1, R1 had combative behavior which created an unsafe environment to other residents at the facility.

This poses a potential health and safety risk to residents in care.
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updated care plan and/or possible placement of R1 by POC due date.
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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: 03/16/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/16/2026
LIC9099 (FAS) - (06/04)
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