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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197602925
Report Date: 07/11/2025
Date Signed: 07/11/2025 03:07:08 PM

Unsubstantiated


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
07/02/2025 and conducted by Evaluator Mayra Cota
PUBLIC
COMPLAINT CONTROL NUMBER: 28-AS-20250702093605
FACILITY NAME:ARBOR VISTAFACILITY NUMBER:
197602925
ADMINISTRATOR:COMMODORE, KIMFACILITY TYPE:
740
ADDRESS:811 E WASHINGTON BLVDTELEPHONE:
(626) 797-7296
CITY:PASADENASTATE: CAZIP CODE:
91104
CAPACITY:69CENSUS: 61DATE:
07/11/2025
UNANNOUNCEDTIME BEGAN:
09:09 AM
MET WITH:Kim Commodore, AdministratorTIME COMPLETED:
03:15 PM
ALLEGATION(S):
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Staff does not treat resident with dignity and respect.
Staff do not intervene when a resident is bullied by another resident.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA), Mayra Cota, conducted an initial 10-day complaint visit to the facility to investigate the allegations mentioned above. LPA Cota, met with Kim Commodore, Administrator, and the reason for the visit was explained.

The investigtion consisted of the following:

LPA Cota, obtained copies of staff and resident rosters, toured common areas of the facility, including resident rooms, interviewed staff #1-6 (S1-S6) and residents #1-7 (R1-R7). Copy of Special Incident Report was also obtained at the time of visit.

***Continues on LIC 9099-C
Unsubstantiated
Estimated Days of Completion:
NAME OF LICENSING PROGRAM MANAGER: Wei Siew Ho
NAME OF LICENSING PROGRAM ANALYST: Mayra Cota
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 07/11/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/11/2025
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-20250702093605
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: ARBOR VISTA
FACILITY NUMBER: 197602925
VISIT DATE: 07/11/2025
NARRATIVE
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Regarding allegation Staff does not treat resident with dignity and respect.

It is alleged that staff did not provide privacy when a resident brought up issues regarding another resident who pesters and bullies resident. It is also alleged that staff interrogated a resident while resident was upset and crying due to emotional distress and embarrassment caused by onlookers at the facility. During visit, interviews with S1-S6 revealed, residents are never interrogated when a concern is brought up to staff. Staff stated, residents can speak openly and are provided privacy to talk about their concerns in the administrative offices in which they can close the door to avoid any information from being divulged to others. Staff also stated, they conduct visits to resident rooms if they need to follow up on concerns privately with residents. Staff further indicated, confidentiality is accorded to residents by letting them report concerns without pressuring them to speak more than they want to share if a problem is reported. S1-S6 stated, they treat all residents with dignity and respect and reassure residents that they can report any concerns they have about staff or residents at any time and will work to bring their concerns to resolution. Interviews with R1-R7 revealed, residents can report concerns to staff confidentially. Residents stated, they know they can speak to administrative staff privately in their offices, privately. Residents also stated, they have no concerns about staff not furnishing private spaces to talk when they have concerns regarding facility staff or residents. Residents further indicated, staff conduct room visits to check in and talk to them privately if needed. Residents also stated, they are treated with respect and dignity by all staff, especially administrative staff. LPA observation indicated, administrative staff have two offices in which residents can visit to talk to staff at any time. The two administrative offices have comfortable space and seating area for residents. Residents were allowed to close the door to the administrator’s office to talk to LPA during time of visit. LPA observation also indicated, staff were observed making regular rounds to resident's rooms during the course of the visit. Staff and resident interviews and LPA observations, do not corroborate the allegation.

***Continues on LIC 9099-C

NAME OF LICENSING PROGRAM MANAGER: Wei Siew Ho
NAME OF LICENSING PROGRAM ANALYST: Mayra Cota
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 07/11/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/11/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 28-AS-20250702093605
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: ARBOR VISTA
FACILITY NUMBER: 197602925
VISIT DATE: 07/11/2025
NARRATIVE
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Regarding: Staff do not intervene when a resident is bullied by another resident.

It is alleged that resident reported to staff that they are living in a hostile environment due to a resident pestering and bullying resident. Interviews with S1-S7 indicated, they have not witnessed any resident on resident bullying nor any sort of pestering behavior. Staff stated, the facility hardly ever has any incidents in which bullying is reported; however, if concerns are brought up regarding any issues with residents or even with staff, they speak to parties involved privately in administrative offices to work on resolution. Staff indicated, facility informs all residents regarding their rights to report bullying and other issues to staff during Resident Council monthly meetings, and any opportunity to discuss the topic with residents. Staff also indicated that the facility has a reporting grievances policy in place and residents are highly encouraged to report any issue immediately. Interviews with (6) out of (7) residents revealed that they have no concerns regarding bullying or other pestering behaviors either from other residents or staff and furthermore, they have not witnessed bullying or pestering behavior from any residents toward other residents. Six (6) out of (7) residents stated, they like living at the facility and they feel supported by staff, especially the administrator to whom they can express their concerns, and they can talk to privately in the administrative offices to ensure privacy. One (1) resident stated, they do not recall an incident of bullying or pestering behavior toward a resident; however, resident stated, they know they can report any incident to administrative staff at any time. Staff and resident interviews do not corroborate the allegation.


Although the allegation may have happened or is valid, there is no preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegation is UNSUBSTANTIATED. An exit interview was conducted, with Kim Commodore and a copy of this report was provided.
NAME OF LICENSING PROGRAM MANAGER: Wei Siew Ho
NAME OF LICENSING PROGRAM ANALYST: Mayra Cota
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 07/11/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/11/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 3