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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198603483
Report Date: 04/09/2026
Date Signed: 04/09/2026 12:17:13 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK ASC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754
This is an official report of an unannounced visit/investigation of a complaint received in our office on
09/02/2025 and conducted by Evaluator Sanjay Vaid
PUBLIC
COMPLAINT CONTROL NUMBER: 28-AS-20250902121024
FACILITY NAME:ASSISTED LIVING & WELLNESS - NAOMIFACILITY NUMBER:
198603483
ADMINISTRATOR:SANDOVAL, JENNIFERFACILITY TYPE:
740
ADDRESS:220 W. NAOMI AVETELEPHONE:
(626) 315-2561
CITY:ARCADIASTATE: CAZIP CODE:
91007
CAPACITY:6CENSUS: 4DATE:
04/09/2026
UNANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH:Licensee, Kenny YuTIME COMPLETED:
12:30 PM
ALLEGATION(S):
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The licensee did not obtain proper city clearances
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Vaid conducted a subsequential visit to the facility and delivered complaint findings to the facility. LPA Vaid was met by Staff #2(S2), Licensee was notified and arrived soon after.
LPA requested, obtained and reviewed the staff and resident rosters.

LPA Vaid and staff#2 conducted a physical plant tour and observed the residents Health and Safety with double doors linking the two facilities being used by the staff to facilitate residents in both facilities, double -doors may allow visitors to access both facilities.

On 09/08/2025, LPA Vaid conducted the initial visit. LPA Vaid was met by Caregiver, Tatiana Equida, who allowed LPA Vaid entry into the facility and notified the administrator of LPA presence. LPA Vaid spoke with Administrator Jenifer Sandoval and purpose of the visit was discussed regarding the above-mentioned allegations. Administrator Jenifer Sandoval was not available due to personal issues. Licensee Kenny Yu met with LPA Vaid and the complaint allegations were discussed. LPA requested, obtained and reviewed the staff and resident rosters.
CONTINUED ON 9099C
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Fernando Fierros
LICENSING EVALUATOR NAME: Sanjay Vaid
LICENSING EVALUATOR SIGNATURE:

DATE: 04/09/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/09/2026
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 6
Control Number 28-AS-20250902121024
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK ASC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754
FACILITY NAME: ASSISTED LIVING & WELLNESS - NAOMI
FACILITY NUMBER: 198603483
VISIT DATE: 04/09/2026
NARRATIVE
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Regarding the allegation: The licensee did not obtain proper city clearances. It is alleged that the Licensee is operating a 6-bed facility adjacent and accessible to a 4-bed facility via double doors, which links the two facilities. It is also alleged that the licensee does not have the proper occupancy code clearance, and did not obtain the proper city clearances to operate a ten-bed facility. Interviews with Licensee revealed the purpose of the double doors is to facilitate staff with residents’ care. Interviews with four of four staff denied this allegation. Staff stated the 6-bed and 4-bed facilities were approved for operations by Community Care Licensing. The license to operate a Residential Care Facility for Elderly was issued on 10/08/2021. Interviews with six of six residents revealed that residents could not corroborate the allegation; as the facility residents are not knowledgeable with the facility operations. According to records reviewed during the investigation, the City of Arcadia, Planning and Zoning, Development Services Department, Codes Services Division issued Notice of Violation and Notice to Abate a Public Nuisance to the facility dated 05/29/25, 06/12/25, 07/17/25, 07/31/25. The notices indicate the violation address and state that the location is in violation for the following Arcadia Municipal Code Section(s) and Corrective Action.
• AMC 9402.6B, - Any unsafe building or structure as defined by Section 116 of the California Building Code, as adopted by Article VIII of the Arcadia Municipal Code
• AMC9402.6D, - A building or structure or part thereof which was constructed, or partially constructed, without complying with applicable provisions of the Arcadia Municipal Code or other law.
• 9402.6P.1 - Buildings which are abandoned, boarded up without City direction, partially destroyed, or partially constructed or uncompleted building after building permits have expired.
• AMC 9402.6.F - Any partially constructed building or structure, together with material and equipment used for construction, which is not completed within a reasonable time, or upon which there is a cessation of work for more than sixty (60) days
• AMC 9402.6.E - Any building or structure or portion thereof which cannot be lawfully used in its existing location and condition for any purpose for which it is designed.
• CBC 105.1 Permits Required

The violation address is 220 W Naomi Ave, Arcadia CA 91007-6911. The facility has not corrected the violations which were due within a fifteen-day (15-day) time frame. Per the City of Arcadia, Planning and Zoning, Development Services Department, Codes Services Division, the violations and violation due dates were provided to the Licensee and to date, proof of corrections have not been received.

CONTINUED ON 9099C
SUPERVISORS NAME: Fernando Fierros
LICENSING EVALUATOR NAME: Sanjay Vaid
LICENSING EVALUATOR SIGNATURE:

DATE: 04/02/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/09/2026
LIC9099 (FAS) - (06/04)
Page: 5 of 6
Control Number 28-AS-20250902121024
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK ASC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754
FACILITY NAME: ASSISTED LIVING & WELLNESS - NAOMI
FACILITY NUMBER: 198603483
VISIT DATE: 04/09/2026
NARRATIVE
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The Corrective Action items listed below have not been corrected:
• Contact Building & Safety Division to remove or acquire permits for the unpermitted structure(s).
• Correct substandard condition of property
• Contact the Building & Safety Division to renew or cancel your permit; if you are canceling your permit, properly remove all construction material and equipment from the property.
• Contact the Building & Safety Division to acquire proper permits
• Renew all expired building permits
• Pass all final inspections
• Obtain proper permits for change of occupancy
The licensee did not furnish the department with a final inspection report, city permits for the occupancy class code, therefore, an updated fire safety inspection will be requested with the City of Arcadia Fire Department to ensure the residents health and safety.

Based on LPAs observations and interviews which were conducted and record review, the preponderance of evidence standard has been met, therefore the above allegation is found to be substantiated. California Code of Regulations, (Title 22, Division 6 & Chapter 8), are being cited on the attached LIC 9099D.

Exit interview was conducted. Copy of LIC 9099, 9099C, 9099D and appeals were provided to licensee.
SUPERVISORS NAME: Fernando Fierros
LICENSING EVALUATOR NAME: Sanjay Vaid
LICENSING EVALUATOR SIGNATURE:

DATE: 04/09/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/09/2026
LIC9099 (FAS) - (06/04)
Page: 6 of 6
Control Number 28-AS-20250902121024
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK ASC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754

FACILITY NAME: ASSISTED LIVING & WELLNESS - NAOMI
FACILITY NUMBER: 198603483
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/09/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
04/30/2026
Section Cited
CCR
87305(b)
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87305 Alterations to Existing Building or New Facilities (b)The licensing agency may require the facility to acquire a local building inspection where the agency determines that a suspected hazard to health and safety exists.
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Licensee will submit proof of corrections and final City of Arcadia inspection permits to the Department by 04/30/26.
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This requirement has not been met with evidence: The licensee did not furnish the department with a final inspection report, city permits for the occupancy class code, therefore, an updated fire safety inspection will be requested with the City of Arcadia Fire Department to ensure the residents health and safety.
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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.
SUPERVISORS NAME: Fernando Fierros
LICENSING EVALUATOR NAME: Sanjay Vaid
LICENSING EVALUATOR SIGNATURE:

DATE: 04/09/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/09/2026
LIC9099 (FAS) - (06/04)
Page: 2 of 6
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK ASC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754
This is an official report of an unannounced visit/investigation of a complaint received in our office on
09/02/2025 and conducted by Evaluator Sanjay Vaid
PUBLIC
COMPLAINT CONTROL NUMBER: 28-AS-20250902121024

FACILITY NAME:ASSISTED LIVING & WELLNESS - NAOMIFACILITY NUMBER:
198603483
ADMINISTRATOR:SANDOVAL, JENNIFERFACILITY TYPE:
740
ADDRESS:220 W. NAOMI AVETELEPHONE:
(626) 315-2561
CITY:ARCADIASTATE: CAZIP CODE:
91007
CAPACITY:6CENSUS: 4DATE:
04/09/2026
UNANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH:Licensee, Kenny YuTIME COMPLETED:
12:30 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
The facility is operating beyond the limits of the license
INVESTIGATION FINDINGS:
1
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5
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Licensing Program Analyst (LPA) Vaid conducted a subsequential visit to the facility and delivered complaint findings to the facility. LPA Vaid was met by staff #2(S2), Licensee was notified and arrived soon after.

LPA Vaid and staff#2 conducted a physical plant tour and observed total of six residents in the 6-bed facility.
LPA requested, obtained and reviewed the staff and resident rosters.

On 09/08/2025, LPA Vaid conducted the initial visit. LPA Vaid was met by Caregiver, Tatiana Equida, who allowed LPA Vaid entry into the facility and notified the administrator of LPA presence. LPA Vaid spoke with Administrator Jenifer Sandoval and purpose of the visit was discussed regarding the above-mentioned allegations. Administrator Jenifer Sandoval was not available due to personal issues. Licensee Kenny Yu met with LPA Vaid and the complaint allegations were discussed. LPA requested, obtained and reviewed the staff and resident rosters.

CONTINUED ON 9099C...............
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Fernando Fierros
LICENSING EVALUATOR NAME: Sanjay Vaid
LICENSING EVALUATOR SIGNATURE:

DATE: 04/09/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/09/2026
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 3 of 6
Control Number 28-AS-20250902121024
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK ASC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754
FACILITY NAME: ASSISTED LIVING & WELLNESS - NAOMI
FACILITY NUMBER: 198603483
VISIT DATE: 04/09/2026
NARRATIVE
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Regarding the allegation: The facility is operating beyond the limits of the license. It is alleged that the licensee is operating beyond the limits of the license by allowing the facility to house more residents than the capacity allows. Today's census is four (4) residents.
Interviews with licensee revealed the allowable capacity of six (6) residents is always maintained. Interviews with four of four staff deny this allegation and revealed that staff reported giving assistance to six (6) residents. Interviews with six of six residents could not corroborate the allegation; the residents do not know the facility capacity limitations and management operations. On 10/08/2021, Community Care Licensing issued a license to operate a Residential Care Facility for Elderly with a capacity of six (6) residents residing in the facility. Additionally, a fire clearance was granted on 08/04/2021 and the facility is approved to retain one (1) ambulatory and five (5) bedridden in room numbers 1, 2, 3, 5 and 6 only. According to LPAs observations and records reviewed, the facility is retaining six (6) residents and is not operating beyond the limits of the license. Based on records review and observations, although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is unsubstantiated.

Exit interview was conducted and copy of LIC 9099 was provided to licensee.
SUPERVISORS NAME: Fernando Fierros
LICENSING EVALUATOR NAME: Sanjay Vaid
LICENSING EVALUATOR SIGNATURE:

DATE: 04/09/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/09/2026
LIC9099 (FAS) - (06/04)
Page: 4 of 6