197603374-7-16-2026-28-AS-BTAO-DW2RAT-20260716125142

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197603374
Report Date: 07/16/2026
Date Signed: 07/16/2026 12:51:59 PM

Document Has Been Signed on 07/16/2026 12:51 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK ASC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754

FACILITY NAME:	COMMUNITY ASSISTANCE PROGRAM FOR SENIORS		FACILITY NUMBER:	197603374
ADMINISTRATOR/ DIRECTOR:	ELIZABETH NADEAU		FACILITY TYPE:	775
ADDRESS:	3740 E. SIERRA MADRE BLVD.		TELEPHONE:	(626) 351-5427
CITY:	PASADENA	STATE: CA	ZIP CODE:	91107
CAPACITY: 26		CENSUS: 12	DATE:	07/16/2026
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	08:28 AM
MET WITH:	Elizabeth Morgan Nadeau, Administrator		TIME VISIT/ INSPECTION COMPLETED:	01:00 PM

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Licensing Program Analyst (LPA) Tao conducted an unannounced annual visit at the facility using the CARE inspection tool. LPA met with the Licensee Vatche Kelartinian and Program Director Elizabeth Morgan Nadeau joined the visit shortly after. The reason for the visit was explained to them.

The facility is an Adult Day Program with a capacity of 26 consumers, licensed to serve Adults and Elderly ages of 55 and over. Its approved fire clearance is 26 Non-Ambulatory clients. The facility is a building at the back of a church located in a residential area in Pasadena. The building consists of an office, storage room, bathroom with multiple stalls, and a large program room which includes a kitchenette area.

The following CARE tool domains were reviewed during this visit:

Infection Control: Sufficient PPE supplies and an Infection Control Plan maintained at the facility were observed and in compliance.

Physical Plant & Environment Safety: Physical plant tour was conducted in the Program Room, bathroom and office, and they were observed to be in compliance. Sharps were stored in a locked cabinet and inaccessible to adults. First Aid kit was reviewed. The facility maintains a bin with adequate emergency food supply. Sharps were stored in a locked cabinet and inaccessible to adults. First Aid kit was reviewed. The facility maintains a bin with adequate emergency food supply. (-Continued on the LIC809-C)

NAME OF LICENSING PROGRAM MANAGER: Lisa Hicks
NAME OF LICENSING PROGRAM ANALYST: Bonnie Tao
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 07/16/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/16/2026

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)

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California Health & Human Services Agency

California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:

Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.

Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)

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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION 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: COMMUNITY ASSISTANCE PROGRAM FOR SENIORS	FACILITY NUMBER: 197603374
	VISIT DATE: 07/16/2026

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Smoke detectors and carbon monoxide detectors were operable. Fire extinguishers were fully charged and the last service day was 9/9/25. Hygiene products were available for clients. Water temperature was measured at 115.5 degrees F., which were in compliance with regulations. The backyard, outdoor and passageways were free of hazards.

Operational Requirements and Disaster Preparedness: Facility maintains documentation of the required emergency drills. Fire drills were conducted monthly. The last fire drill was on 7/9/26.

Staffing and Personnel Records- Training: Staff files and clients’ files were reviewed and in compliance with the regulations. Annual fees are current.

Client Rights-Information and client Records-Incident Reports: Facility provided telephone landline and internet for the clients. Client rights posters and reporting posters were displayed within the facility.

Food Service: The kitchen was observed to be clean. The facility provided snacks to adults. Refrigerator was only to store snacks. Meals were prepared by a food vendor and delivered to the facility daily.

Health Related Service: Medication was properly labeled, centrally stored, and in their original containers. Facility only assisted adults with over-the-counter medication.

Exit:

No deficiencies were noted during this visit per California Code of Regulations, Title 22, Division 6. Exit interview was conducted with Program Director Elizabeth Morgan Nadeau and LIC 809 were provided.

NAME OF LICENSING PROGRAM MANAGER: Lisa Hicks
NAME OF LICENSING PROGRAM ANALYST: Bonnie Tao
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 07/16/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/16/2026

LIC809 (FAS) - (06/04)

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