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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197606145
Report Date: 03/22/2024
Date Signed: 03/22/2024 05:02:07 PM


Document Has Been Signed on 03/22/2024 05:02 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 HOTELFACILITY NUMBER:
197606145
ADMINISTRATOR:PAMELA PARSONSFACILITY TYPE:
740
ADDRESS:720 W. CAMINO REALTELEPHONE:
(626) 574-8571
CITY:ARCADIASTATE: CAZIP CODE:
91007
CAPACITY:200CENSUS: 152DATE:
03/22/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
02:30 PM
MET WITH:Pamela Parsons, administrator and
David Chirikian, Chief operations officer
TIME COMPLETED:
05:15 PM
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Licensing Program Analyst (LPA) Tao conducted an unannounced site inspection for the expansion of dementia unit on the 2nd floor at the facility. LPA met with Administrator, Pamela Parsons, and Chief operations officer, David Chirikian.

The capacity remained the same as 200 residents which included 175 non-ambulatory and 25 bedridden, ages 60 and above. The facility had approved twenty-three (23) Hospice Waivers and approved dementia wing on the first floor which has delayed egress that consisted of 11 rooms. Facility has an approved Dementia Care Plan in their plan of operation to accept residents with dementia.

Fire clearance:
Fire clearance is granted for 200 residents which included 175 non-ambulatory and 25 bedridden on 03/20/24.

Structure:
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. Today’s visit is regarding the new expansion of the dementia unit on the 2nd floor. This unit included 11 residents’ rooms and one dining room with delayed egress. (- continued LIC 809 C -)
SUPERVISOR'S NAME: Fernando FierrosTELEPHONE: (323) 981-3981
LICENSING EVALUATOR NAME: Bonnie TaoTELEPHONE: (323) 981-3971
LICENSING EVALUATOR SIGNATURE:
DATE: 03/22/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/22/2024
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: 03/22/2024
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Bedrooms and Bathrooms for residents:
Bedrooms are spacious, accommodated for residents and in compliance with regulation. Bathrooms have grab bars maintained for each toilet, bathtub and shower.

Linens & Hygiene Supplies:
Sufficient linen/supplies which include pillowcases, mattress pads, blanket and bedspreads are available. Adequate supply of linen, wash clothes and towels are observed.

Smoke Detectors/Signal system:
Smoke /carbon monoxide detectors are tested and operable which are located in hallways and each bedroom. Signal system is tested and operational.

Residents & Staff Files:
Locked cabinets for records of staff and residents are installed and available. No resident is currently residing at this new unit.

Water Temperature:
Water was measured at a range of 110.6 to 112.9 degrees Fahrenheit which was in compliance with Reg Title 22.

Fire extinguishers/ delayed egress:
Fire extinguisher was fully charged, and last fire inspection was on 3/20/24. Delayed egress was operational.

Finding:
No issue was observed during today’s visit. Exit conference was conducted with administrator. A copy of this report was provided.
SUPERVISOR'S NAME: Fernando FierrosTELEPHONE: (323) 981-3981
LICENSING EVALUATOR NAME: Bonnie TaoTELEPHONE: (323) 981-3971
LICENSING EVALUATOR SIGNATURE:

DATE: 03/22/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/22/2024
LIC809 (FAS) - (06/04)
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