197606145-3-12-2024-28-AS-BTAO-D3AVUV-20240312164521

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197606145
Report Date: 03/12/2024
Date Signed: 03/12/2024 04:45:58 PM

Document Has Been Signed on 03/12/2024 04:45 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
CCLD Regional Office, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754

FACILITY NAME:	ARCADIA GARDENS RETIREMENT HOTEL		FACILITY NUMBER:	197606145
ADMINISTRATOR:	PAMELA PARSONS		FACILITY TYPE:	740
ADDRESS:	720 W. CAMINO REAL		TELEPHONE:	(626) 574-8571
CITY:	ARCADIA	STATE: CA	ZIP CODE:	91007
CAPACITY:	200	CENSUS: 155	DATE:	03/12/2024
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	08:00 AM
MET WITH:	Pamela Parsons, administrator		TIME COMPLETED:	05:00 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	Licensing Program Analyst (LPA) Tao conducted an unannounced annual inspection visit. LPA met with Administrator, Pamela Parsons. The facility is licensed to serve for a capacity of 200 residents including 175 non-ambulatory and 25 bedridden residents, ages 60 and above. The facility is approved for twenty-three (23) hospice residents and has an approved Dementia Care Plan. Annual licensing fees are current. Administrator certificate is current, and the expiration date is 07/31/24. During the visit, the CARE tool was used, a tour of the facility was conducted, food supply was reviewed, staff/residents were interviewed, facility records were reviewed, and medications were reviewed. The facility is located in a residential neighborhood, consists of three floors/levels and has 186 resident bedrooms and bathrooms. Resident bedrooms, memory care unit, recreation/activity rooms, beauty shop, storage rooms, employee lounge, library and laundry rooms are located at the lower level. Reception/lounge area, resident bedrooms, dining room, kitchen, multiple offices, recreation/activity rooms and laundry room are located at main level. Upper level consists of resident bedrooms, nurse's office, penthouse, recreation/activity rooms and laundry room. (-continued in LIC 809 C-)

SUPERVISOR'S NAME: Fernando Fierros	TELEPHONE: (323) 981-3981
LICENSING EVALUATOR NAME: Bonnie Tao	TELEPHONE: (323) 981-3971
LICENSING EVALUATOR SIGNATURE:	DATE: 03/12/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/12/2024

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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

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

FACILITY NAME: ARCADIA GARDENS RETIREMENT HOTEL	FACILITY NUMBER: 197606145
	VISIT DATE: 03/12/2024

NARRATIVE

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LPA conducted a physical plant. Residents’ rooms were well furnished and in compliance. The bathrooms inspected were clean, operable, with the required grab bars and non-skid materials in the shower. Hot water temperature was in a range of 106.2 - 110.5 degrees Fahrenheit which was within Title 22 Regulation guidelines. Adequate linen and personal hygiene supplies was observed. The resident rooms had signal systems. LPA randomly tested the signal system in different resident's room on each level and they were operable. Staff arrived at residents' rooms to respond the calls in a range of 3 to 5 minutes. The facility phones for residents’ use were located at the front desk and operable. Auditory alarm devices to monitor exits were operable at the memory care unit at the lower level.

Sufficient supply of perishable and nonperishable foods were observed. The last Fire/Emergency Drill was conducted on 03/12/24. Smoke detectors and carbon monoxide detectors were operable. Outside grounds were toured and pool/spa area with self-latching fenced gate was observed. The outdoor activity area has a shaded patio with ample seating.

Medications were centrally stored and locked in the nurse's office on the upper level. Resident records were stored in a locked cabinet and inaccessible to residents. Toxic substances were inaccessible to residents.

No deficiencies were observed and cited per California Code of Regulations, Title 22.
An exit interview was conducted. This report is discussed and provided to facility Administrator.

SUPERVISOR'S NAME: Fernando Fierros	TELEPHONE: (323) 981-3981
LICENSING EVALUATOR NAME: Bonnie Tao	TELEPHONE: (323) 981-3971
LICENSING EVALUATOR SIGNATURE:	DATE: 03/12/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/12/2024

LIC809 (FAS) - (06/04)

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