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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198602244
Report Date: 01/16/2025
Date Signed: 01/16/2025 12:23:27 PM

Document Has Been Signed on 01/16/2025 12:23 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:PASADENA ADULT LIVING CENTERFACILITY NUMBER:
198602244
ADMINISTRATOR/
DIRECTOR:		GARCIA, RUBYFACILITY TYPE:
735
ADDRESS:1415 N GARFIELD AVETELEPHONE:
(626) 398-9647
CITY:PASADENASTATE: CAZIP CODE:
91104
CAPACITY: 136TOTAL ENROLLED CHILDREN: 0CENSUS: 79DATE:
01/16/2025
TYPE OF VISIT:Case Management - Health ChecksUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:02 PM
MET WITH:Ruby Gacia, AdministratorTIME VISIT/
INSPECTION COMPLETED:
01:00 PM
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Licensing Program Analyst (LPA) Vaid made an unannounced case management visit regarding a self-reported incident on the relocation of seventy-nine (79) residents to Pasadena Adult Assisted Living Center, Pasadena (license # 198602244, located at 1415 N Garfield Ave, Pasadena, 91104). Due to the mandatory evacuation orders from Fire Advisory. LPA met with Ruby Garcia Administrator of Pasadena Adult Living Center and explained the purpose of the visit.
During the visit, LPA Vaid conducted a health and safety check and no concerns observed. LPA requested residents/staff rosters for facility was obtained. Per the interview with administrator Ruby Garcia, seventy-nine (79)) residents have been repopulated back to Pasadena Adult Living Center.
Ten (10) clients to Vista Del Sol-11620 Washington LA. Ten (10) clients to Bonnie Brae Convalescent Hospital- 420 S Bonnie Brae, LA. Twelve (12) clients to Corona Care-1400 E circle City Dr, Corona. Three (3) client to Driftwood Health Care 4109 Emerald St, Torrance. Eight (8) clients to Coral Oaks Care- 4271 Carlin Ave, Lynwood. Sixteen (16) clients to Palm Retirement- 312 N Roosevelt Ave, Fullerton. Eleven (11) clients to Wyngate Villas Garden- 7634 Wyngate St, Tujunga. One (1) client to Country View AL- 824 W Cameron Ave, West Covina. Two clients are in hospital and three (3) are on home visit and will return by the weekend. Clients observed to be happy to return.
The residents are back in Pasadena Adult Living Center and the facility has sufficient beds, hygiene supplies, beddings, linens, and everyone is back in their designated rooms. Residents’ rooms and bathrooms are in compliance with the required furnishing. Medications, MARs, and staff/ residents’ files have been transferred to Pasadena Adult Living Center facility and stored in the locked cabinets. Kitchen appliances are working properly. Facility has 2-day perishables and 7 days non-perishable. Food inventory is received on Tuesday and Fridays.
Administrator Garcia and staff are maintaining level of cleanliness, needs and services to clients throughout the facility. Vendors, pharmacy, and are provide the same level of care to residents. There is sufficient staffing available to provide care for residents at the facility. Ruby Garcia Administrator confirmed all residents’ families/ responsible parties have been notified about the repopulation of the facility, either via calls, texts, or emails.
No issues are observed during the visit. An exit interview was conducted, and a copy of this report was provided to Ruby Garcia.
Fernando FierrosTELEPHONE: (323) 981-3981
Sanjay VaidTELEPHONE: 916-215-7924
DATE: 01/16/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/16/2025
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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