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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198603374
Report Date: 06/22/2022
Date Signed: 06/22/2022 09:49:13 AM


Document Has Been Signed on 06/22/2022 09:49 AM - 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 LIVING LLCFACILITY NUMBER:
198603374
ADMINISTRATOR:BIELY, NOEMIFACILITY TYPE:
740
ADDRESS:601 SUNSET BOULEVARDTELEPHONE:
(951) 907-9888
CITY:ARCADIASTATE: CAZIP CODE:
91007
CAPACITY:130CENSUS: 48DATE:
06/22/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Director of Resident Services, Jennifer Lan, RNTIME COMPLETED:
10:00 AM
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Licensing Program Analyst (LPA)/Retired Annuitant (RA) Elizabeth Ceniceros conducted an unannounced visit to this facility to deliver two (2) complaint findings that were unrelated to this facility. However, due to a change of ownership as of February 17, 2021 and (former) Administrator (Noemi Biely) no longer working at the facility as of November 2021, LPA/RA will mail the complaints to (former) Licensee: Vista Cove at Arcadia, Inc (#197607476).
SUPERVISOR'S NAME: Araceli RamirezTELEPHONE: (323) 980-4925
LICENSING EVALUATOR NAME: Elizabeth CenicerosTELEPHONE: (916) 264-1579
LICENSING EVALUATOR SIGNATURE:
DATE: 06/22/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/22/2022
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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