198603286-10-24-2025-28-AS-LHIS-DNXQJA-20251201111224

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198603286
Report Date: 10/24/2025
Date Signed: 10/24/2025 03:27:23 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
08/20/2025 and conducted by Evaluator Bennette Pena

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20250820145116

FACILITY NAME:	PASADENA VILLA SENIOR LIVING		FACILITY NUMBER:	198603286
ADMINISTRATOR:	MURPHY, MICHAEL		FACILITY TYPE:	740
ADDRESS:	1811 N. RAYMOND AVE		TELEPHONE:	(626) 791-6232
CITY:	PASADENA	STATE: CA	ZIP CODE:	91103
CAPACITY:	97	CENSUS: 59	DATE:	10/24/2025
		UNANNOUNCED	TIME BEGAN:	02:00 PM
MET WITH:	Bryanna Luke - Administrator		TIME COMPLETED:	03:30 PM

ALLEGATION(S):

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Facility staff did not provide adequate supervision, resulting in non-consensual sexual behavior amongst residents.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Bennette Pena conducted a subsequent complaint visit regarding the above mentioned allegation. LPA met with Administrator, Bryanna Luke and explained the purpose of the visit.

This investigation was conducted by Investigator Santana with the Investigations Branch and consisted of the following: On 08/21/2025 and 09/15/2025, LPA Pena conducted a tour of facility and common areas, obtained a copy of the Staff and Resident rosters, Facility sketch, House rules, Home Health Notes, pertinent files for Resident #1 (R1) - Resident #2 (R2), Unusual Injury/Incident Reports (May - Aug 2025), Nurse's Notes, SOC341 (08/21/2025), R1’s hospital discharge records and Pasadena Police Dept report #2025-65144.

During today's visit, LPA obtained a copy of the Staff and Resident rosters, delivered findings and issued a separate Case Management-Deficiencies. ******CONTINUED ON LIC9099-C*****

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: David Sicairos
LICENSING EVALUATOR NAME: Bennette Pena
LICENSING EVALUATOR SIGNATURE:	DATE: 10/24/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/24/2025

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-20250820145116

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: PASADENA VILLA SENIOR LIVING	FACILITY NUMBER: 198603286
	VISIT DATE: 10/24/2025

NARRATIVE

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This investigation was completed by Investigator Santana with the Investigations Branch and revealed the following:

Allegation: Facility staff did not provide adequate supervision, resulting in non-consensual sexual behavior amongst residents. It is alleged that R1 was inappropriately touched on their private parts by R2 in the dining room on 08/08/2025 because of neglect/lack of supervision at the facility. Interviews and surveillance video made it clear that during R1’s month-long stay at the facility, that R2, who was not cognitively impaired, was romantically pursuing R1, who had dementia. It was also known to facility management that R2 had a history of allegedly making unwanted physical contact with female residents. Staff members witnessed two incidents on 8/01/2025 and 8/07/2025 in which R2 touched R1's thigh and both incidents were reported to facility management. Despite these witnessed incidents, no available facility surveillance footage of the dining room showed R2 touching R1’s breasts or groin. Furthermore, interviewed witnesses were unable to identify the location of the alleged incident, and the claimed witness denied seeing anything. Interview conducted with R1 revealed that there were 2-3 times when R2 touched them inappropriately, however, R1 was unwilling to provide further details. Pasadena Police Department took a report but did not investigate further. As a result, the allegation that R2 touched R1's breasts and/or groin is therefore Unsubstantiated.

Based on statements and interviews conducted with residents and staff as well as reviewed files and documentation, there was not enough supportive evidence to corroborate the 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 allegation is UNSUBSTANTIATED.

Exit interview conducted and a copy of this report was provided to Bryanna Luke, Administrator.

SUPERVISORS NAME: David Sicairos
LICENSING EVALUATOR NAME: Bennette Pena
LICENSING EVALUATOR SIGNATURE:	DATE: 10/24/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/24/2025

LIC9099 (FAS) - (06/04)

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