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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198603445
Report Date: 05/26/2023
Date Signed: 05/26/2023 05:24:25 PM


Document Has Been Signed on 05/26/2023 05:24 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:BRANCONIER, AMBERFACILITY TYPE:
740
ADDRESS:753 W DUARTE ROADTELEPHONE:
(626) 445-7981
CITY:ARCADIASTATE: CAZIP CODE:
91007
CAPACITY:120CENSUS: 103DATE:
05/26/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Amber Branconier, Licensee
Staff#2, Director of operation		TIME COMPLETED:
05:00 PM
NARRATIVE
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 Licensing Program Analyst (LPA) Tao conducted an unannounced annual inspection visit. LPA met with staff#2 (S2) and Licensee/administrator, Amber Branconier and discussed the purpose of today's 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 Waiver on file. Currently, one (1) resident is on hospice. Annual licensing fees are current.

During the visit, the CARE tool was used, physical plant/facility tour was conducted, food supply was reviewed, staff/residents’ files were reviewed, and medications were reviewed.

The facility is located at the residential area. The premise is a two-story building with 60 resident rooms. Facility consists 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 are centrally stored and locked in the medication room. Medication records are current.

Hallways were clean and free of obstructions. Common areas were well organized and free of hazards. Hazardous items are locked and inaccessible to residents in care. LPA inspected 10 (ten) residents’ rooms of room#103, #107, #109, #203, #204, #207, #211, #212, #233 and #237. Resident bedrooms had furniture, lighting fixture and personal storage space as required. Mattress pads were 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 108.8 to 115.5 degrees Fahrenheit which was within Title 22 Regulation guidelines. Adequate linen and personal hygiene supplies were observed.

(-continued in LIC 809C-)
SUPERVISOR'S NAME: Fernando FierrosTELEPHONE: (323) 981-3981
LICENSING EVALUATOR NAME: Bonnie TaoTELEPHONE: (323) 981-3971
LICENSING EVALUATOR SIGNATURE:
DATE: 05/26/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/26/2023
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: ARCADIAN, THE
FACILITY NUMBER: 198603445
VISIT DATE: 05/26/2023
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Signal systems were tested in resident rooms. The system was functional and staff responded to resident rooms within five minutes. Last fire inspection and facility fire drill were conducted on 03/17/23.

Sufficient supplies of perishable and non-perishable foods were 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 74 degrees Fahrenheit maintained throughout the entire facility.

Smoke detectors and carbon monoxide detectors were tested and operational. Fire extinguishers were fully charged and last fire inspection was conducted on 03/17/23. Auditory alarm devices at exits were working. First aid kits were fully stocked with manual. All mandated documents and signages are posted in common areas. There is shaded outdoor area with ample seating. No bodies of water observed.



Deficiencies were cited per California Code of Regulations, Title 22. Administrator certificate is not current and facility did not have a qualified administrator. See LIC 809D for details.

An exit interview was conducted. This report and appeal rights were discussed and provided to facility Licensee, 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: 05/26/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/26/2023
LIC809 (FAS) - (06/04)
Page: 2 of 3
Document Has Been Signed on 05/26/2023 05:24 PM - It Cannot Be Edited

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

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/26/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
87405(a)
Administrator - Qualifications and Duties
87405(a) All facilities shall have a qualified and currently certified administrator.

This requirement is not met as evidenced by:
Per staff file reviews, administrator certificate was expired and facility did not have a qualified administrator.
Deficient Practice Statement
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Based on record review, the licensee did not comply with the section cited above which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 06/02/2023
Plan of Correction
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Licensee will hire a qualified administrator, provide proof of administrator qualification per Title 22 regulation and submit administrator certificate to CCLD by the POC due date.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Fernando FierrosTELEPHONE: (323) 981-3981
LICENSING EVALUATOR NAME: Bonnie TaoTELEPHONE: (323) 981-3971
LICENSING EVALUATOR SIGNATURE:
DATE: 05/26/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/26/2023
LIC809 (FAS) - (06/04)
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