198603566-12-5-2023-28-AS-TVAO-CYFNZZ-20231212095508

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198603566
Report Date: 12/05/2023
Date Signed: 12/05/2023 02:10:29 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
GREATER LA AC/SC, 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
08/01/2023 and conducted by Evaluator Mary G Flores

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20230801093641

FACILITY NAME:	ASTORIA PARK SENIOR LIVING		FACILITY NUMBER:	198603566
ADMINISTRATOR:	GOODLETT, BRIANNA		FACILITY TYPE:	740
ADDRESS:	925 EAST VILLA STREET		TELEPHONE:	(626) 796-4303
CITY:	PASADENA	STATE: CA	ZIP CODE:	91106
CAPACITY:	220	CENSUS: 94	DATE:	12/05/2023
		UNANNOUNCED	TIME BEGAN:	12:28 PM
MET WITH:	Stephanie Funderburg- Administrator		TIME COMPLETED:	02:25 PM

ALLEGATION(S):

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Staff did not prevent a resident from being sexually abused while in care.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Mary Flores conducted a subsequent compliant investigation visit regarding the above allegation. LPA met with Stephanie Funderburg and explained the reason for the visit.

The investigation consisted of the following: On 8/1/23 LPA Flores conducted a Health and Safety check visit at the facility and requested copies of the following documents staff/resident roster, admission agreement, physician's report, identification and emergency information sheet, needs and care plan, medication sheet for July 2023, incident reports, notes on resident #1 and #2 (R1-R2), staff schedules for the month of July 2023. On 8/22/23 and 8/25/23 IB investigator Sonia Sandoval from the department’s Investigation Bureau conducted interviews with R1, and 3 staff(S1-S3). On 10/18/23 LPA Flores contacted Pasadena’s Police Department. On 10/18/23 and 11/8/23 LPA Flores left a voice for Detective at Special Victim Unit. On 12/4/23 LPA Flores conducted interviews with 5 additional residents.

(CONTINUED ON LIC 9099C)

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Tony Vasallo	TELEPHONE: (818) 419-8131
LICENSING EVALUATOR NAME: Mary G Flores	TELEPHONE: (323) 981-3965
LICENSING EVALUATOR SIGNATURE:	DATE: 12/05/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/05/2023

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-20230801093641

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
GREATER LA AC/SC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754

FACILITY NAME: ASTORIA PARK SENIOR LIVING	FACILITY NUMBER: 198603566
	VISIT DATE: 12/05/2023

NARRATIVE

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The investigation revealed the following: Regarding allegation: Staff did not prevent a resident from being sexually abused while in care. It is alleged a male resident inappropriately touched a female resident. Per administrator at the time of the incident, On 7/22/23 staff #2(S2) observed R1 exit the elevator and was startled, upon S2 asking R1 what was going on. R1 reported that R2 had touched R1 inappropriately while in the elevator. S2 reported it to management and management reviewed the video surveillance footage in the elevator. On 7/24/23 after reviewing surveillance video administrator reported it to the proper agencies. On 7/27/23 Officer Tucker from Pasadena Police Department assisted with the call regarding the alleged abuse at the facility. Officer Tucker reviewed the video surveillance, in which it was observed both residents entering the elevator in the second floor. Then R2 holds R1 hand once inside the elevator and turns in an attempt to hug R1 by placing hands around R1’s waist. R2 grabs R1’s hand and attempts to place it in R2’s hip, then R2 places R2's head over R1’s left shoulder with R2's face facing R1’s shoulder. R2 is seen speaking to R1, in response R1 pushes R2 away saying “No” twice and “stopped it”. R1 attempted to pull away, but R2 would not let go. Residents are observed exiting the elevator in the first floor holding hands. However, R1 stays back and is able to let go of R2’s hand. It is then that S2 observed R1 agitated and reported to have heard R1 saying “No. Stop” from inside the elevator. Officer Tucker attempted to interview R1 and due to cognitive skills R1 was not able to remember the incident. On 8/22/23 a second attempt to interview R1 was attempted by IB investigator, who was not able to obtain information due to R1’s cognitive skills. On 10/18/23 LPA spoke with intake officer from Pasadena Police Department who stated the report was forward to Special Victim Unti (SVU). On 10/18/23 and 11/1/23 LPA attempted to speak to the detective reviewing the case but was not able to obtain information. Documents reviewed do not revealed any history of related behaviors for R2. R1 and R2 were either on minimal assistance or independent care. R2 moved out of the facility on 8/27/23 and the department was unable to interview R2. Interviews with additional residents revealed residents are respectful with each other and staff are available and responsive to any situations. Although, the incident may have occurred there is not enough evidence to support that R2 had a history of behaviors or notes in change of condition, allowing the facility to have an action plan to prevent the incident from happening.

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

Exit interview was conducted with Stephanie Funderburg and a copy of this report was provided.

SUPERVISOR'S NAME: Tony Vasallo	TELEPHONE: (818) 419-8131
LICENSING EVALUATOR NAME: Mary G Flores	TELEPHONE: (323) 981-3965
LICENSING EVALUATOR SIGNATURE:	DATE: 12/05/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/05/2023

LIC9099 (FAS) - (06/04)

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