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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198603566
Report Date: 11/04/2025
Date Signed: 11/04/2025 12:33:43 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
10/27/2025 and conducted by Evaluator Daniel Konishi
PUBLIC
COMPLAINT CONTROL NUMBER: 28-AS-20251027173421
FACILITY NAME:ASTORIA PARK SENIOR LIVINGFACILITY NUMBER:
198603566
ADMINISTRATOR:STEPHANIE FUNDERBURGFACILITY TYPE:
740
ADDRESS:925 EAST VILLA STREETTELEPHONE:
(626) 796-4303
CITY:PASADENASTATE: CAZIP CODE:
91106
CAPACITY:220CENSUS: 152DATE:
11/04/2025
UNANNOUNCEDTIME BEGAN:
09:05 AM
MET WITH:Stephanie Funderburg, Executive DirectorTIME COMPLETED:
12:45 PM
ALLEGATION(S):
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Staff did not prevent a physical altercation between residents in care
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Daniel Konishi conducted an initial 10-day complaint visit at the facility and met with the Executive Director, Stephanie Funderburg to discuss the purpose for today's visit. The purpose of the visit is to investigate the above allegation.

Investigation consisted of the following: LPA requested a copy of staff and resident rosters. LPA also requested copies from Resident#1 (R1’s) file such as: Face Sheet, Physician’s Report, House Rules, Resident Handbook, SOC341, and Incident Reports. LPA also obtained Staff training documents. LPA also requested copies of Resident #2 (R2’s) file such as: Face Sheet and Physician’s Report. LPA interviewed R1 to Resident #6 (R6), the Executive Director, and Staff #1 (S1) to Staff #6 (S6).

The investigation revealed the following: In regards to the allegation, “Staff did not prevent a physical altercation between residents in care.” It is alleged on 10/25/2025 at 4:29pm, Resident #1 (R1) yelled at Resident #2 (R2) and R1 slapped the left side of R2’s face at the hallway on the way to the dining hall and staff separated the two residents.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: David Sicairos
LICENSING EVALUATOR NAME: Daniel Konishi
LICENSING EVALUATOR SIGNATURE:

DATE: 11/04/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/04/2025
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-20251027173421
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: ASTORIA PARK SENIOR LIVING
FACILITY NUMBER: 198603566
VISIT DATE: 11/04/2025
NARRATIVE
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 It is also alleged that R1 was unprovoked. LPA interviewed two (2) staff that denied the allegation stating on witnessing the incident and immediately de-escalating and separating both R1 and R2. LPA interviewed an additional five (5) out of five (5) staff that all denied the allegation and stated the staff immediately intervene, separate, and re-direct residents whenever they are involved in a physical altercation. LPA interviewed R1 that denied the allegation by stating that R1 did not hurt R2 or anyone by the hallway near the dining hall. LPA interviewed R2 that denied the allegation by stating not being yelled or slapped by R2 by the hallway near the dining hall. LPA interviewed an additional four (4) out of four (4) residents denied the allegation by stating not witnessing the physical altercation between both R1 and R2. However, the four (4) out of (4) residents stated that staff immediately intervene to de-escalate verbal or physical altercations by separating the residents. LPA reviewed ongoing staff training on De-Escalating Dementia Behavior and Residents’ Rights in file. There was insufficient evidence to corroborate with the allegations.

Based on statements and interviews conducted with staff, clients, review of client 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.

Exit interview was held, and a copy of this report was provided to the Executive Director, Stephanie Funderburg.
SUPERVISORS NAME: David Sicairos
LICENSING EVALUATOR NAME: Daniel Konishi
LICENSING EVALUATOR SIGNATURE:

DATE: 11/04/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

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