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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198603566
Report Date: 06/23/2026
Date Signed: 06/23/2026 09:24:57 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
06/17/2026 and conducted by Evaluator Cynthia D Chan
PUBLIC
COMPLAINT CONTROL NUMBER: 28-AS-20260617114724
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:
06/23/2026
UNANNOUNCEDTIME BEGAN:
09:15 AM
MET WITH:Maria Quizon, AdministratorTIME COMPLETED:
04:30 PM
ALLEGATION(S):
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Staff did not administer medication as prescribed.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Cynthia Chan conducted a complaint investigation on the allegation listed above. LPA met with Executive Director, Maria Quizon, and informed the purpose of the visit.

The investigation consisted of the following:
LPA obtained copies of the staff and resident rosters, reviewed medication for ten (10) residents, and interviewed six (6) staff and ten (10) residents.

The investigation revealed the following:
Allegation - Staff did not administer medication as prescribed. It is alleged that staff did not administer the donepezil medication for Resident #1 (R1) on 6/16/26, and that the medication Olanzapine changed from 15mg to 10mg was not administered because staff was not aware of the change.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Fernando Fierros
LICENSING EVALUATOR NAME: Cynthia D Chan
LICENSING EVALUATOR SIGNATURE:

DATE: 06/23/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/23/2026
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-20260617114724
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: 06/23/2026
NARRATIVE
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LPA conducted a review of the medication for ten (10) residents during the visit today. LPA observed discrepancies for six (6) out of ten (10) medications and their Medication Administration Record (MAR) logs. LPA found that several of the medications were missing from the cart and/or were pending refills from the pharmacy. Other discrepancies included a medication for one resident was already administered for tomorrow, 6/24/26, and staff indicated the open date of 6/1/26. Additionally, the staff initial was not indicated for R1’s morning medications on 6/20/26.

Interviews with staff revealed that there are times when medications were not fulfilled timely due to pending physician authorization or that the pharmacy did not receive the on-cycle medications timely. LPA also interviewed ten (10) residents. Four (4) out of the ten (10) had issues with medications not administered due to staff not receiving the medication from the pharmacy.

Based on interviews conducted and record review, the preponderance of evidence standard has been met, therefore, the above allegation is found to be SUBSTANTIATED. California Code of Regulations, (Title 22, Division 6 and Chapter 8), are being cited on the attached LIC9099D.



An exit interview was conducted. The Plan of Correction was reviewed and developed with the Executive Director. A copy of this report and appeal rights were provided.
SUPERVISORS NAME: Fernando Fierros
LICENSING EVALUATOR NAME: Cynthia D Chan
LICENSING EVALUATOR SIGNATURE:

DATE: 06/23/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/23/2026
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 28-AS-20260617114724
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: 06/23/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
06/24/2026
Section Cited
CCR
87465(a)(4)
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87465 Incidental Medical and Dental Care (a) A plan for incidental medical and dental care shall be developed by each facility. (4)The licensee shall assist residents with self-administered medications as needed.
This requirement is not met as evidenced by:
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Licensee shall conduct an inservice on medication training and submit a plan to ensure medications are administered as prescribed. This plan is due on 6/24/26.
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Based on medication review, there were discrepancies found in six out of ten residents' medications which poses an immediate health and safety risk to residents in care.
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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: Cynthia D Chan
LICENSING EVALUATOR SIGNATURE:

DATE: 06/23/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/23/2026
LIC9099 (FAS) - (06/04)
Page: 3 of 3