198601778-7-22-2025-28-AS-CDCN-DJU3GK-20250722181429

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 198601778
Report Date: 07/22/2025
Date Signed: 07/22/2025 06:15:50 PM

Document Has Been Signed on 07/22/2025 06:15 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:	BROOKDALE UPTOWN WHITTIER		FACILITY NUMBER:	198601778
ADMINISTRATOR/ DIRECTOR:	PRECIOSA (SUZIE) MAGPAYO		FACILITY TYPE:	740
ADDRESS:	13250 E PHILADELPHIA ST		TELEPHONE:	(562) 945-3904
CITY:	WHITTIER	STATE: CA	ZIP CODE:	90601
CAPACITY: 280		CENSUS: 121	DATE:	07/22/2025
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	09:00 AM
MET WITH:	Suzie Magpayo, Administrator		TIME VISIT/ INSPECTION 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) Cynthia Chan conducted the required annual inspection on 7/22/25. LPA arrived unannounced and met with the Executive Director, Suzie Magpayo. The facility is licensed to serve 280 non-ambulatory residents, ages 60 and over. There is a hospice waiver approved for 8 residents. LPA inspected the facility using the Compliance and Regulatory Enforcement (CARE) tools. The facility is a 4-story building with resident rooms on each floor. The first floor consists of the main lobby, dining room, kitchen, lounge, activity room, conference room, medication room, and resident rooms. The 2nd, 3rd, and 4th floors consist mainly of resident rooms, activity rooms, and laundry rooms. The facility also has a Wellness Center. LPA randomly selected 12 rooms (#106, #103, #119, #201, #231, #243, #301, #311, #317, #345, #402, and #423 to inspect. The bathrooms have non-skid mats and the hot water temperature was measured within range of 105-120 degrees F. Smoke detectors and carbon monoxide detectors are operable. Facility has sufficient space to accommodate indoor and outdoor activities. There are daily planned activities. Sufficient food supplies of 2-day perishable and a week of non-perishable items as well as water supply were observed. Information for appropriate reporting agencies are posted at the facility. The facility does not accept or retain residents with dementia. Residents utilizing oxygen tanks have signs posted at the front door. Facility is continuing to follow their infection control plan and using appropriate hand hygiene. Gloves are worn by staff while assisting residents with their activities of daily living. The liability insurance is still current for the coverage of at least $1 million (per occurrence) and $3 million (total annual aggregate). Per the administrator, there is sufficient staffing for each shift. LPA reviewed 6 personnel files. The Administrator's certificate expires on 8/10/25. The staff files have the required documents and have fingerprint clearance. Staff have current CPR and First Aid certificates.

NAME OF LICENSING PROGRAM MANAGER: Fernando Fierros
NAME OF LICENSING PROGRAM ANALYST: Cynthia D Chan
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 07/22/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/22/2025

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: BROOKDALE UPTOWN WHITTIER	FACILITY NUMBER: 198601778
	VISIT DATE: 07/22/2025

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LPA reviewed 10 resident files. The files contain the admission agreement, medical assessment with TB results, consent forms, property valuable form, pre-appraisal form, and care plan. Medications are centrally stored in a locked cart in the med room. The medications were checked for 10 residents and no discrepancies were found.
The Emergency Disaster Plan and Infection Control Plan are reviewed annually. The facility receives unannounced fire drills/disaster drills training for each shift from the Fire Safety Service Company.

No deficiencies issued today. An exit interview was held and a copy of this report was given to Administrator S. Magpayo.

NAME OF LICENSING PROGRAM MANAGER: Fernando Fierros
NAME OF LICENSING PROGRAM ANALYST: Cynthia D Chan
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 07/22/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/22/2025

LIC809 (FAS) - (06/04)

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