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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198603445
Report Date: 04/22/2022
Date Signed: 04/22/2022 03:38:56 PM


Document Has Been Signed on 04/22/2022 03:38 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:ARCADIAN, THEFACILITY NUMBER:
198603445
ADMINISTRATOR:STARNES, CINDIFACILITY TYPE:
740
ADDRESS:753 W DUARTE ROADTELEPHONE:
(626) 445-7981
CITY:ARCADIASTATE: CAZIP CODE:
91007
CAPACITY:120CENSUS: 73DATE:
04/22/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:15 AM
MET WITH:Amber Branconier, Licensee
Martha Garcia, Staff		TIME COMPLETED:
04:00 PM
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Licensing Program Analysts (LPAs) Tao and Calderon conducted an unannounced annual inspection visit. LPAs met with Martha Garcia, staff who assisted with the visit. Around 1:30 pm, Licensee, Amber Branconier joined the visit and assisted with the visit. The facility has a capacity of 120 residents. It is licensed to serve elderly residents age 60 and above, approved for 120 non-ambulatory residents of which 21 may be bedridden. The facility has five (5) Hospice Waivers on file. Annual licensing fees are current. LPAs discussed the purpose of today's visit.

During the visit, the infection control domain tool was used, a tour of the facility was conducted, food supply was reviewed, and medications were reviewed.



The facility is a two-story building with 60 resident rooms. Facility consisted of Lobby/Reception Area, office, medication room, Activity Room, TV/Entertainment Room, Beauty Shop, Employee Room with lockers and time clock, laundry room, kitchen, and dining room. Residents' medications were centrally stored, locked and the records are current. Hazardous items are locked and inaccessible to residents in care. Hallways were clean and free of obstructions. Common areas were well organized and free of hazards. LPAs inspected Resident room # 103, 106, 120, 216 and 225. Resident bedrooms had furniture, lighting fixtures and personal storage space as required, mattress pads observed on all beds, the required amount of linen also observed. Bathrooms inspected were clean, operable, and furnished with the required grab bars and non-skid materials in the shower. Hot water temperature was in a range of 109.1 to 113.9 degrees Fahrenheit which was within Title 22 Regulation guidelines. Adequate linen and personal hygiene supplies were observed. Signal systems were tested in resident rooms. The system was operable and staff responded to resident rooms within five minutes. Last Fire Drill was conducted 02/13/2022. Administrator certificate is current and expiration date is 06/12/2022.
(-continued in LIC 8089C-)
SUPERVISOR'S NAME: Fernando FierrosTELEPHONE: (323) 981-3981
LICENSING EVALUATOR NAME: Bonnie TaoTELEPHONE: (323) 981-3971
LICENSING EVALUATOR SIGNATURE:
DATE: 04/21/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/21/2022
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: ARCADIAN, THE
FACILITY NUMBER: 198603445
VISIT DATE: 04/22/2022
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Sufficient supply of perishable and non-perishable foods was observed. Refrigerators, freezers, microwaves, ovens and counter tops observed to be clean. Sufficient supplies of plates, cups, glasses and utensils for the current census was observed. A comfortable temperature of 75 degrees Fahrenheit maintained throughout the entire facility.

Smoke detectors and carbon monoxide detectors were tested and operable. Fire extinguishers were fully charged and last fire inspection was conducted on 01/21/22. Auditory alarm devices at exits were operable. First aid kits were fully stocked with manual. All mandated documents and signages were posted in common areas. There was shaded outdoor area with ample seating. No bodies of water observed.



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

An exit interview was conducted. This report is discussed and provided to facility Licensee, Amber Branconier, whose signature on this form confirm receipt of these documents.
SUPERVISOR'S NAME: Fernando FierrosTELEPHONE: (323) 981-3981
LICENSING EVALUATOR NAME: Bonnie TaoTELEPHONE: (323) 981-3971
LICENSING EVALUATOR SIGNATURE:

DATE: 04/22/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/22/2022
LIC809 (FAS) - (06/04)
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