198603566-7-2-2026-28-AS-LHIS-DXHLDG-20260901083953

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198603566
Report Date: 07/02/2026
Date Signed: 07/02/2026 05:55:55 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
06/29/2026 and conducted by Evaluator Bonnie Tao

COMPLAINT CONTROL NUMBER: 28-AS-20260629081405

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: 154	DATE:	07/02/2026
		UNANNOUNCED	TIME BEGAN:	11:45 AM
MET WITH:	Maria Quizon, Administrator		TIME COMPLETED:	05:30 PM

ALLEGATION(S):

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The facility has insufficient staffing.
The facility mismanages residents' medication while in care.

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 allegations mentioned above to administrator Maria Quizon.

The investigation consisted of resident interviews, staff interviews, physical plant tour and facility records reviews. LPA obtained resident roster, staff roster, staff work schedule, clock in and out time log for June 2026, and resident’s medication records.

The investigation revealed the following:

In regard of the allegation that the facility has insufficient staffing, it is alleged that facility does not have enough med tech, especially during the night shift. Per resident interviews, three (3) out of ten (10) residents could not corroborate with the allegation. (-continued on LIC 9099C-)

Substantiated

Estimated Days of Completion:

SUPERVISORS NAME: Lisa Hicks
LICENSING EVALUATOR NAME: Bonnie Tao
LICENSING EVALUATOR SIGNATURE:	DATE: 07/02/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/02/2026

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-20260629081405

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: 07/02/2026

NARRATIVE

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Seven (7) out of ten (10) residents indicated there were not enough staff when they need medication assistance during the nighttime (NOC shift). Per staff interviews, one (1) out of five (5) staff indicated staff was not aware of short of staff. Four (4) out of five (5) staff interviewed were corroborated with the allegation. It revealed that staff were aware that only one (1) night shift med tech to assist residents from both memory care and assisted living units in some days. Per record review, the time log showed there was only one med tech to assist both memory care and assisting living units in some days during evening or night shift. Therefore, facility staff do not have sufficient number of care staff.

In regard of the allegation that the facility mismanages residents' medication while in care, it is alleged that facility staff did not provide medication assistance and administer medication properly to residents. Per resident interviews, three (3) out of ten (10) residents could not corroborate with the allegation. Seven (7) out of ten (10) residents indicated they did not get their medication as prescribed. Per staff interviews, one (1) out of five (5) staff indicated staff was not aware of short of staff. Four (4) out of five (5) staff interviewed were corroborated with the allegation. It revealed that staff were aware that some residents’ medication was not administered as prescribed due to staffing issues. Per record and medication review, LPA found multiple residents’ medication mismanagement. Licensee did not have an explanation about medication and record discrepancy. Therefore, facility mismanaged residents’ medication.

Based on record review, medication reviews 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. Copies of this report and appeal rights were provided.

SUPERVISORS NAME: Lisa Hicks
LICENSING EVALUATOR NAME: Bonnie Tao
LICENSING EVALUATOR SIGNATURE:	DATE: 07/02/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/02/2026

LIC9099 (FAS) - (06/04)

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Control Number 28-AS-20260629081405

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: 07/02/2026

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type A 07/03/2026 Section Cited CCR 87465(a)(4)	1 2 3 4 5 6 7	(4) The licensee shall assist residents with self-administered medications as needed. This requirement is not met as evidenced by:	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
	8 9 10 11 12 13 14	R1 BM Atorvastatin - did not administer one doze in July; R2 AP- Acetaminophen 325 mg, 500 mg and Mucus Relief 600 mg were missing the med cart; R3 KP- Nubequa 300 mg - did not administer for mulitple days; R4 CR -Dimethyl Fumarat 240mg, Eliquis 2.5 mg and Famotidine 20 mg did not administer to resident for muliple days; R11 PB- Amlodipine Besylate 5mg- short 1 pill and Bisacodyl - missing 1 pill. 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 personsin care.	8 9 10 11 12 13 14	statement indicating the review of this section detailing how to prevent future medication errors by the POC date.
Type B 07/09/2026 Section Cited CCR 87464(f)(4)	1 2 3 4 5 6 7	Basic services shall at a minimum include:...Personal assistance and care as needed by the resident ... and assistance with taking prescribed medications. This requirement is not met as evidenced by:	1 2 3 4 5 6 7	Licensee agreed to esure enough Med Tech and staff to provide proper medication assistance to residents. Licensee will provide proof of hiring additional med tech to provide assistance to residents. POC by due date.
	8 9 10 11 12 13 14	Per staff and residents’ interviews, there were not sufficent staff to provide medication assistance to residents to meet residents' needs. This poses a potential health and safety risk to residents in care.	8 9 10 11 12 13 14

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

SUPERVISOR'S NAME: Lisa Hicks
LICENSING EVALUATOR NAME: Bonnie Tao
LICENSING EVALUATOR SIGNATURE:	DATE: 07/02/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/02/2026

LIC9099 (FAS) - (06/04)

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