198603374-1-13-2023-28-AS-BTAO-CN32ZP-20230113165040

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 198603374
Report Date: 01/13/2023
Date Signed: 01/13/2023 04:51:37 PM

Document Has Been Signed on 01/13/2023 04:51 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:	ARCADIA LIVING LLC		FACILITY NUMBER:	198603374
ADMINISTRATOR:	JINGFANG JENNIFER ZHANG		FACILITY TYPE:	740
ADDRESS:	601 SUNSET BOULEVARD		TELEPHONE:	(626) 447-0106
CITY:	ARCADIA	STATE: CA	ZIP CODE:	91007
CAPACITY:	130	CENSUS: 47	DATE:	01/13/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	09:30 AM
MET WITH:	Jennifer Zhang, administrator		TIME 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) Tao conducted an unannounced annual inspection visit. LPA met Administrator, Jennifer Zhang and explained the purpose of the visit. The facility has a capacity of 130. Its' fire clearance is approved for fifty-one seventy-one (71) ambulatory, (51) non-ambulatory, eight (8) bedridden and three (3) hospice waivers. Current resident census is forty three (43). Two (2) residents are on hospice. Annual fees are current. During the visit, the infection control domain tool was used, a tour of the facility was conducted, staff and residents were interviewed, staff and resident records were reviewed, food supply was reviewed, and medications were reviewed. The facility is located in a residential area. A physical tour is conducted. The facility is a three-story 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. A large, covered patio area, with a closed off fishpond located on the premises. The kitchen is clean and has maintained the required two (2) days perishable and seven (7) days non- perishable. All burners and stove tops were in working condition. Residents' bedrooms have dresser, chair and closet space available. Adequate linen and personal hygiene supply are observed. Bathrooms inspected were clean, operable, with the required grab bars and non-skid materials in the shower. Hot water temperature was in a range of 108.7 to 115.1 degrees Fahrenheit which was within Title 22 Regulation guidelines. Adequate linen and personal hygiene supplies. Signal system was tested and staff arrived to assist residents in a range of 3 to 5 minutes. (-continued in 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: 01/13/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/13/2023

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: 01/13/2023

NARRATIVE

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Smoke detectors and carbon monoxide detectors are operable. Smoke detectors in the hallway and bedrooms are hard wired and monitored by a fire prevention company. Fire extinguishers are fully charged and last service is on 12/5/22. The last Fire/ Emergency Drill was conducted on 9/5/2022. All mandated documents and signages are posted in common areas. The outdoor activity area has a shaded patio with ample seating. Medication are centrally stored in a locked medication room and inaccessible to residents. Resident records are stored in an office and inaccessible to residents. There are no firearms on the premises. Facility maintains a comfortable temperature for residents.

Administrator certificate is current and the expiration date is 7/20/24

No deficiencies cited per California Code of Regulations, Title 22.

An exit interview was conducted. This report is discussed and provided to facility Administrator, whose signature on this form confirm receipt of these documents.

SUPERVISOR'S NAME: Fernando Fierros	TELEPHONE: (323) 981-3981
LICENSING EVALUATOR NAME: Bonnie Tao	TELEPHONE: (323) 981-3971
LICENSING EVALUATOR SIGNATURE:	DATE: 01/13/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/13/2023

LIC809 (FAS) - (06/04)

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