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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197602925
Report Date: 11/17/2025
Date Signed: 11/17/2025 12:32:31 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
11/14/2025 and conducted by Evaluator Mayra Cota
PUBLIC
COMPLAINT CONTROL NUMBER: 28-AS-20251114120011
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: 53DATE:
11/17/2025
UNANNOUNCEDTIME BEGAN:
09:12 AM
MET WITH:Kim Commodore, AdministratorTIME COMPLETED:
12:45 PM
ALLEGATION(S):
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Facility is in disrepair.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA), Mayra Cota, conducted an unnanounced 10-day complaint visit today to investigate the above mentioned allegation. LPA met with Kim Commodore, Administrator, and the reason for the visit was explained.

The investigation consisted of the following:

LPA, obtained copies of staff and resident rosters, toured the facility’s indoor and outdoor environment with a focus on inspecting the ceilings and roof, inspected (14) resident rooms, interviewed Staff 1 – Staff 7 (S1-S7) and Resident 1 – Resident 7 (R1-R7). LPA also conducted record reviews and obtained copies of the facility insurance policy renewal.

The investigation revealed the following:
***Continues on LIC 9099-C
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Wei Siew Ho
LICENSING EVALUATOR NAME: Mayra Cota
LICENSING EVALUATOR SIGNATURE:

DATE: 11/17/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/17/2025
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 2
Control Number 28-AS-20251114120011
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: 11/17/2025
NARRATIVE
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Regarding: Facility is in disrepair.

It is alleged that the facility has tarps over several parts of the facility's roof and that there may be leaks in the building which have not been addressed due to the rain. It is also alleged that several utility vans were observed parked close to the facility's main entrance and parking lot.

Staffy deny the allegation. Interviews with (7) out of (7) staff indicated that the facility does not have leaks due to the rain. Staff indicated that they have not observed any leaks in any part of the facility. Staff further indicated that residents have not reported any leaks in the common areas of the facility or in resident rooms. Interviews with S1 and S2 indicated that the tarp was placed over the main office area as a preventative measure. S1 and S2 indicated that last year’s rain caused a minor leak in a corner of the main office; however, the leak was repaired, and water did not continue to drip down from the ceiling. S1 and S2 further indicated that maintenance staff conduct on-going checks of the physical plant to ensure that disrepairs get fixed in a timely manner. Interview with S1 indicated that their insurance carrier conducted an inspection in August, 2025, after the city’s fires which happened near the facility. S1 stated that the facility was found to be in good repair, including the roof for the whole building and renewal their policy was issued by their carrier after the inspection was finalized. S1 and S2 also indicated that no immediate repairs were needed and that the vehicles parked outside belong to the city who is rebuilding sidewalks in front of the facility. LPA inspected 14 resident rooms, including the second story part of the building, kitchen, dining area, offices, main activity room, hallways and the building’s roof. LPA observed the ceiling and roof to be free of leaks and there was no indication that water had been filtering in and staining the ceiling. Further inspection indicated that the tarp is placed over the main office area, and the tarp is not covering other parts of the building’s roof. During today’s visit, LPA observed that the utility vehicles were not present during the visit; however, the sidewalk outside of the facility by the parking lot is coned off to prevent pedestrian activity due to work being conducted to restore plumbing under the sidewalk. Signage observed by LPA further indicated that the cones are property of the city. Review of facility’s insurance documents indicated that on 8/22/25, the facility was able to renew their policy for the term ending in 1/1/2026. Policy indicates that the property meets criteria to continue with coverage of the policy as indicated by inspection of the facility, and its findings.

Based on interviews, record reviews and observations, the allegation that the facility is in disrepair could not be corroborated. Although the allegation may have happened or is valid, there is no preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is unsubstantiated. An exit interview was conducted, and a copy of this report was provided.

SUPERVISORS NAME: Wei Siew Ho
LICENSING EVALUATOR NAME: Mayra Cota
LICENSING EVALUATOR SIGNATURE:

DATE: 11/17/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/17/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 2