198603374-10-16-2020-28-AS-BTAO-BUFRJN-20201016130414

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 198603374
Report Date: 10/15/2020
Date Signed: 10/16/2020 01:05:53 PM

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 LIVING LLC		FACILITY NUMBER:	198603374
ADMINISTRATOR:	BIELY, NOEMI		FACILITY TYPE:	740
ADDRESS:	601 SUNSET BOULEVARD		TELEPHONE:	(951) 907-9888
CITY:	ARCADIA	STATE: CA	ZIP CODE:	91007
CAPACITY:	130	CENSUS: 60	DATE:	10/15/2020
TYPE OF VISIT:	Prelicensing	ANNOUNCED	TIME BEGAN:	10:00 AM
MET WITH:	Noemi Biely, Applicant/administrator		TIME COMPLETED:	05:30 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 announced pre-licensing inspection. This is a change of ownership application. LPA met Noemi Biely, applicant/administrator. The applicant is Arcadia Living LLC. The facility was previously licensed to Vista Cove at Arcadia, Inc with facility # 197607476. Due to the situation surrounding the Coronavirus Disease 2019 (COVID-19), and to implement mitigation measures, today’s inspection was conducted telephonically with Applicant. An application was submitted to CCLD on 06/08/20, for change of ownership for a Residential Care Facility for the Elderly to serve the Elderly for 60 years and older. The requested capacity is 130 for 71 ambulatory, 51 non-ambulatory and 8 bedridden. Structure: The facility is a stucco structure with 83 bedrooms, 86 bathrooms, 1 TV room, an administrative office, a restaurant style kitchen, a laundry room, a janitor storage room, and two elevators. The facility has a gas fire place in the activity room with a metal screen cover and is inaccessible to residents. There is a large, covered patio area, with a fish pond on the premises. The resident bedrooms are spacious and will easily accommodate the client's furnishings. Passageways, walkways, stairs and patios are free from obstructions. The entrance and side areas are free of hazards and debris. Signal system: Facility has a signal system. It operates properly. (-continued 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: 10/15/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/15/2020

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 LIVING LLC	FACILITY NUMBER: 198603374
	VISIT DATE: 10/15/2020

NARRATIVE

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Bedrooms for Residents:
Bedroom has a chair, nightstand, adequate lighting, adequate closet and drawer space. Bedrooms are spacious and allow for easy passage between and comfortable for usage of assistant devices such as walkers.

Bathrooms:
All bathrooms have a working toilet, wash basin, bathtub/shower. Bedrooms for non-ambulatory residents are accommodated for residents in a wheelchair.

Linens & Hygiene Supplies:
Beds have the required linen/supplies which include, pillowcase, mattress pads, fitted sheet, blanket and bedspreads. Adequate supply of linen stored in storage room.

Emergency Phone Numbers, Exit Plan & Menu:
Emergency Disaster Plan is posted at the lobby near the entrance. Menus are available for review.
Free landline telephone is available for residents’ use and operable.
Eighteen fire extinguishers are available in the facility. They are located near kitchen door mounted on wall, hallways of each floor, exits of each floor and TV lounge room. They are fully charged and last service was done in April 2020.

Food Service:
Dishes, cups and flat ware are stored in the kitchen cupboards, inspected and in good repair. Knives, cutlery and other sharp kitchen utensils are stored in a locked drawer in the kitchen. Food supply adequate stored and consists of two days of perishable and two weeks of non-perishable. Dishwasher in kitchen properly installed and functioning.

Smoke Detectors:
Smoke detector is hard wired. Carbon monoxide detectors located in hallway of each floor and are operational.

(-Continued 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: 10/15/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/15/2020

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 LIVING LLC	FACILITY NUMBER: 198603374
	VISIT DATE: 10/15/2020

NARRATIVE

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Appliances:
Stove burners, oven, microwave, washer, and dryer working. There are two refrigerators in the kitchen including a walk-in refrigerator and one additional refrigerator for food storage. Each refrigerator has a measured temperature of at least 45 degrees Fahrenheit for appropriate food storage. Freezer is at (0) zero degrees Fahrenheit. The residence is equipped with central air and heat and each client bedroom is individually climate controlled.

Toxins:
Poisons, toxins, and cleaning supplies are locked and inaccessible to residents.

Water Temperature:
Tested at 105. degrees Fahrenheit in room 206 (2^nd floor) and 106.5 degrees Fahrenheit in room 311 (3^rd floor).

Medications, First-Aid Kit & Book:
A first aid kit has been inspected which has at least the following: thermometer, tweezers, scissors, antiseptic, bandages, gauze and current first aid manual, which are stored in administrator office, available for staff use but inaccessible to residents.

Clients & Staff Files:
Applicant will not handle cash resources for residents. Records of staff and clients shall be stored in a locked cabinet and the section has been inspected along with the available records present. The facility has Liability insurance coverage.

Reading Material, Games, Equipment & Materials:
The facility has board games, books, and other recreational materials for the client's use, commensurate with the plan of operation. Due to COVID 19 pandemic, residents are encouraged to have activities in their own room.

Pool:
A fishpond is located at the middle of the facility on the first floor. That area is inaccessible to the residents. A four feet high fence are around the pond. ( - Continued 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: 10/15/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/15/2020

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 LIVING LLC	FACILITY NUMBER: 198603374
	VISIT DATE: 10/15/2020

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Fire clearance:
Fire Clearance with 71 ambulatory, 51 non-ambulatory and 8 bedridden was approved on 07/16/2020.
Residents’ bedrooms do not have security bars. No dementia residents admitted and delayed egress is not installed.

Component III:
Conducted at the Pre-Licensing visit, information provided about how to operate the facility within substantial compliance.

During the pre-licensing inspection certain items were observed which do not comply with applicable laws and regulations.

The following items must be corrected and proof of correction shall be submitted to the CCLD office to the attention of LPA by 10/22/2020. If additional time is required to complete noted items to correct, then the applicant will request an extension in writing prior to the due date. Some items may require a follow up inspection for verification of correction.

1. In the dining room, a section of dining area near the kitchen does not have flooring and tiles. The wall on that section is not painted and electric outlets are not covered. That section is covered with a piece of plastic from the ceiling to the floor.

2. In the kitchen, the floor next to the stove has a wooden board (~3ft x3ft) covering the sewage hole. The floor next to the ice machine has a wooden board (~3ft x 3ft) covering the sewage hole due to the plumbing issue.

A telephonic exit interview was conducted with Administrator, and a hard copy was provided via email for signature.

Accordingly, LPA will submit a copy of this facility evaluation report to the Central Applications Unit (CAU) for review. If the applicant has questions regarding the status of the application, they have been instructed to communicate with the CAU Analyst assigned to their application.

SUPERVISOR'S NAME: Fernando Fierros	TELEPHONE: (323) 981-3981
LICENSING EVALUATOR NAME: Bonnie Tao	TELEPHONE: (323) 981-3971
LICENSING EVALUATOR SIGNATURE:	DATE: 10/15/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/15/2020

LIC809 (FAS) - (06/04)

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