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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197602925
Report Date: 09/24/2026
Date Signed: 09/24/2026 01:39:10 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
06/25/2026 and conducted by Evaluator Sanjay Vaid
PUBLIC
COMPLAINT CONTROL NUMBER: 28-AS-20260625163509
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: 49DATE:
09/24/2026
UNANNOUNCEDTIME BEGAN:
08:50 AM
MET WITH:Cheryl Jaskson, Administrative AssistantTIME COMPLETED:
02:08 PM
ALLEGATION(S):
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Resident was sexually assaulted due to staff neglect
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Vaid conducted a subsequential visit to the facility and met with Administrative Assistant, Cheryl Jackson and discussed the reason for the visit. LPA Vaid and Administrator Assistant Jackson toured the facility and did not observe any health and safety concerns.

On 06/26/2026, Licensing Program Analyst (LPA) Vaid conducted 24-hour visit and was met by Administrator, Kim Commodore. LPA Vaid explained the reason for the visit and discussed the above-mentioned allegation.
LPA Vaid requested, obtained and reviewed the following documents. Resident 1 (R1) and resident 2 (R2), face-sheet, physicians report, and service plan. Staff and residents’ rosters. Resident 1 (R1) disclosure statement and statement follow-up. Unusual Incident Report. Staff contact information.

Narrative continued on next page 9099C.................
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Fernando Fierros
LICENSING EVALUATOR NAME: Sanjay Vaid
LICENSING EVALUATOR SIGNATURE:

DATE: 09/24/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/24/2026
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-20260625163509
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: 09/24/2026
NARRATIVE
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 Regarding the allegation: Resident was sexually assaulted due to staff neglect. It is alleged that due to staff neglect resident #1-R1 was sexually assaulted by another resident. Four (4) of four (4) staff interviewed deny this allegation, staff stated residents residing at the facility having sexual relations with other residents are independent and are not conserved are able to make their own decisions. The staff stated that the residents’ health and safety are not being neglected, residents are free to roam the facility and be invited to other residents’ rooms. The facility is an assisted living environment where residents’ health and mental stability are the focus, residents are free to engage in sexual relations as residents wish. One (1) of six (6) residents stated having consensual sexual relationship with another resident and does not believe staff were neglectful in their duties. One (1) of six (6) residents denied having sexual relationship with another resident. Four (4) of six (6) residents could not corroborate this allegation, residents did not have knowledge of this incident. Based on interviews conducted and records review, 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 was conducted and a copy of this report was provided to Administrator Assistant, Cheryl Jackson.
SUPERVISORS NAME: Fernando Fierros
LICENSING EVALUATOR NAME: Sanjay Vaid
LICENSING EVALUATOR SIGNATURE:

DATE: 09/24/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/24/2026
LIC9099 (FAS) - (06/04)
Page: 2 of 2