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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198603208
Report Date: 04/12/2022
Date Signed: 04/13/2022 12:33:20 PM


Document Has Been Signed on 04/13/2022 12:33 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:LOVING ARMS RESIDENTIAL CARE FOR SENIORS IIIFACILITY NUMBER:
198603208
ADMINISTRATOR:BISNAR, LOURDESFACILITY TYPE:
740
ADDRESS:11507 THOMAS PLACETELEPHONE:
(562) 864-6308
CITY:NORWALKSTATE: CAZIP CODE:
90650
CAPACITY:6CENSUS: 2DATE:
04/12/2022
TYPE OF VISIT:OfficeUNANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH:Crystal LiTIME COMPLETED:
12:30 PM
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An office meeting was held in the Monterey Park Adult and Senior Care Licensing Office with Regional Manager(RM) Araceli Ramirez, Licensing Program Manager(LPM) Lisa Hicks, Licensing Program Analyst(LPA) Nicol Wesley, Licensee Crystal Li and Administrator Lourdes Bisnar were all in attendance.

The purpose of this informal office meeting is to discuss the possible facility closure.

It was addressed in the meeting that the Department was made aware, on 02/16/22, of the facility possibly closing. The following Title 22 Regulation Sections were discussed and materials provided during the meeting;
  • Eviction Procedures 87224 (RCFE)
  • H&S Code 1569.682
  • H&S Code 1569.191
  • PIN 18-17-ASC Facility Closure Requirements
  • Reporting Requirements 87211 (RCFE)

Licensee Crystal Li was made aware of a possible potential buyer and change of ownership for the facility. Phases 1, 2 and 3 were discussed. Phase 1 (draft of the closure plan along with eviction notice, submission of change of ownership application), Phase 2 (following approved closure plan, notifying placement agencies along with LTCO, SS Administration and transitional plan for the new buyer/office meeting), Phase 3 (notification of change of ownership).

(please see LIC 809C for additional information).
SUPERVISOR'S NAME: Lisa HicksTELEPHONE: (323) 981-3972
LICENSING EVALUATOR NAME: Nicol WesleyTELEPHONE: (323) 981-3975
LICENSING EVALUATOR SIGNATURE:
DATE: 04/12/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/12/2022
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: LOVING ARMS RESIDENTIAL CARE FOR SENIORS III
FACILITY NUMBER: 198603208
VISIT DATE: 04/12/2022
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The following documents will be provided by the end of business day on 04/29/22;
  • 60 Days Written Notice
  • Closure Plan (Including: Client Roster, Ambulatory Status, Rent Payee, Conservator/POA/Public Guardian & Clients receiving the Enhanced Service Rate)
  • List of utilities & vendors

According to Crystal Li, there are currently 2 residents residing in the facility who are over the age of sixty (60) years old.

An exit interview was conducted and a copy of this report was provided to Crystal Li.
SUPERVISOR'S NAME: Lisa HicksTELEPHONE: (323) 981-3972
LICENSING EVALUATOR NAME: Nicol WesleyTELEPHONE: (323) 981-3975
LICENSING EVALUATOR SIGNATURE:

DATE: 04/13/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/13/2022
LIC809 (FAS) - (06/04)
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