198603255-3-5-2026-28-AS-DSIS-DS2TBG-20260310143503

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198603255
Report Date: 03/05/2026
Date Signed: 03/05/2026 09:39:48 AM

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
06/23/2025 and conducted by Evaluator Daniel Konishi

COMPLAINT CONTROL NUMBER: 28-AS-20250623164156

FACILITY NAME:	ROSE VALLEY GARFIAS		FACILITY NUMBER:	198603255
ADMINISTRATOR:	HSU, MICHAEL		FACILITY TYPE:	740
ADDRESS:	2346 GARFIAS DR		TELEPHONE:	(626) 486-2663
CITY:	PASADENA	STATE: CA	ZIP CODE:	91104
CAPACITY:	6	CENSUS: 6	DATE:	03/05/2026
		UNANNOUNCED	TIME BEGAN:	09:08 AM
MET WITH:	Monica Aguilera, Administrator		TIME COMPLETED:	09:50 AM

ALLEGATION(S):

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Staff neglect resulted in resident's unexplained fracture while in care.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Daniel Konishi conducted a subsequent unannounced complaint visit in response to the above-mentioned allegations. LPA met with the Administrator, Monica Aguilera and was explained the purpose of the visit.

On 06/25/2025, the initial investigation visit was conducted. The investigation consisted of the following:

LPA Lopez requested a copy of the Staff roster and Resident roster and conducted a tour of facility and common areas. LPA also requested pertinent files for Resident #1 (R1). LPA observed the residents in the facility to identify any signs of neglect, abuse, or other immediate health and safety threats. LPA did not observe any immediate Health and/or Safety concerns. Administrator stated that R1 file is not at facility. Administrator stated that a friend of the R1 took the entire file, and facility was not aware of it until LPA asked for it today. Facility cited on Case management report.

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: David Sicairos
LICENSING EVALUATOR NAME: Daniel Konishi
LICENSING EVALUATOR SIGNATURE:	DATE: 03/05/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/05/2026

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-20250623164156

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: ROSE VALLEY GARFIAS	FACILITY NUMBER: 198603255
	VISIT DATE: 03/05/2026

NARRATIVE

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During today's visit, LPA Konishi obtained the following documents: staff and resident rosters.

The investigation revealed the following: in regard to the allegation, “Staff neglect resulted in resident's unexplained fracture while in care.” It is alleged that R1 sustained a bruise on the right leg and diagnosed with a fracture. This allegation was investigated by the Investigation Bureau (IB) and was assigned to Investigator Miles. LPAs reviewed IB interviews which revealed the following: On 06/10/2025, the day of discovered unexplained injuries, Witness #1 (W1) conducted a regular caregiver visit with R1 at the facility and observed swelling and a dark bruise to R1’s right leg. W1 reported and photographed the unexplained injury to R1’s family member and facility staff. The Administrator and two (2) out of two (2) staff interviewed were unable to provide any information about how R1 obtained the unexplained dark bruise and swelling on the right leg. On 06/14/2025, family member contacted 911 and R1 was transported to the hospital, where R1 presented a “right lower extremity swelling and was found to have a right tibial fracture and deep vein thrombosis (DVT/blood clot).” Per record review, it was observed that R1 was attended to daily by Home Health aides and facility staff. The cause of the fracture is unknown as there were no reported falls and staff interviewed were not sure how or when the injury occurred. Because the mechanism and timing of the injury are unclear, the Department is unable to substantiate that the injury occurred due to facility neglect or lack of care and supervision. There is not enough evidence to substantiate.

Based on statements and interviews conducted with staff, residents, review of residents’ files and facility file records, there was not enough supportive evidence to concur with the reported allegation. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegations are UNSUBSTANTIATED.

An exit interview was held, and a copy of this report was provided to the Administrator, Monica Aguilera.

SUPERVISORS NAME: David Sicairos
LICENSING EVALUATOR NAME: Daniel Konishi
LICENSING EVALUATOR SIGNATURE:	DATE: 03/05/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/05/2026

LIC9099 (FAS) - (06/04)

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