198603566-5-4-2026-28-AS-FFIS-DUFPWR-20260526114111

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198603566
Report Date: 05/04/2026
Date Signed: 05/04/2026 05:28:41 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

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20260313143559

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: 152	DATE:	05/04/2026
		UNANNOUNCED	TIME BEGAN:	08:00 AM
MET WITH:	Administrator Maria Quizon		TIME COMPLETED:	12:00 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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*** This report supersedes the report dated 03/16/26. The superseded report was created due to additional staff/residents interviews were conducted and clarification of the allegation was made. The finding of the allegation remains unchanged. ***

Licensing Program Analyst (LPA) Tao conducted an unannounced subsequent visit today on 05/04/2026 to re-deliver finding. The initial visit was conducted by LPA Tao on 03/16/2026. Today’s visit, LPA Tao met with Administrator Maria Quizon. The purpose of today’s visit was discussed with the Administrator.

The investigation consisted of residents/staff interviews, facility tours, and review of facility records. LPA obtained resident roster, staff roster and residents’ facility files.

The investigation revealed, in regards of facility staff do not ensure residents are safe from harm from other residents, it was alleged that a resident hit other residents with fists and walker. LPA interviewed eleven (11) residents including resident#1 (R1) who was alleged to hit other residents. (- Continued on LIC 9099C-)

Substantiated

Estimated Days of Completion:

SUPERVISORS NAME: Lisa Hicks
LICENSING EVALUATOR NAME: Bonnie Tao
LICENSING EVALUATOR SIGNATURE:	DATE: 05/04/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/04/2026

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-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: 05/04/2026

NARRATIVE

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*** This report supersedes the report dated 03/16/26. The superseded report was created due to additional staff/residents interviews were conducted and clarification of the allegation was made. The finding of the allegation remains unchanged. ***

Per the resident interviews, ten (10) out of eleven (11) residents were corroborated with the allegation which resident#1 (R1) was constantly yelling and threatening to hit or had hit other residents. All residents interviewed were residing on the second floor. They stated R1's situation had been going on for a year and they know what R1 did. Residents stated staff may talk to R1 to redirect R1 but it did not work most of the time. No preventive action was taken to ensure residents were safe from R1’s harm. Per staff interviews, all four (4) staff interviewed were corroborated with the allegation. Administrator was aware of R1’s combative behavior. Per record review, the Administrator handled R1 behavior by consulting psychiatrist and changing R1’s medication for three (3) times. Preventive action was minimal. Per the observation during the interview with resident#1 (R1), LPA went to R1’s room and R1 opened the door. R1 raised resident’s voice when talking to LPA at resident’s room door. Then, R1 used resident’s index finger pointing at LPA and raised voice again 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. During the facility tour later that day, LPA observed R1 walking in the hallway with a walker. R1 was combative and had aggressive behaviors toward other people trying to get other people out of the way in the hallway. LPA did not observe any staff intervention. Therefore, staff failed to ensure residents were safe from harm from other residents.

Based on the information obtained during the investigation, interviews with staff, residents, review of resident files and LPA's observation, 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 Maria. A copy of this report and appeal rights were provided.

SUPERVISORS NAME: Lisa Hicks
LICENSING EVALUATOR NAME: Bonnie Tao
LICENSING EVALUATOR SIGNATURE:	DATE: 05/04/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/04/2026

LIC9099 (FAS) - (06/04)

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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: 05/04/2026

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Deficiency Dismissed Type B 05/05/2026 Section Cited CCR 87464(f)(2)	1 2 3 4 5 6 7	(2) Safe and healthful living accommodations and services. This requirement was not met as evidenced by:	1 2 3 4 5 6 7	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
	8 9 10 11 12 13 14	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.	8 9 10 11 12 13 14	updated care plan and/or possible placement of R1 by POC due date. POC had been cleared prior to the subsequent visit. 5/4/26
	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: Bonnie Tao
LICENSING EVALUATOR SIGNATURE:	DATE: 05/04/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/04/2026

LIC9099 (FAS) - (06/04)

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