198603535-6-30-2026-28-AS-MCOA-DVJTD9-20260630143759

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 198603535
Report Date: 06/30/2026
Date Signed: 06/30/2026 02:38:08 PM

Document Has Been Signed on 06/30/2026 02:38 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
MONTEREY PARK ASC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754

FACILITY NAME:	SANTA ANITA ASSISTED LIVING		FACILITY NUMBER:	198603535
ADMINISTRATOR/ DIRECTOR:	ALISA DEAN		FACILITY TYPE:	740
ADDRESS:	5600 GRACEWOOD AVENUE		TELEPHONE:	(626) 442-8410
CITY:	TEMPLE CITY	STATE: CA	ZIP CODE:	91780
CAPACITY: 150		CENSUS: 144	DATE:	06/30/2026
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	10:45 AM
MET WITH:	Alisa Dean, Executive Director		TIME VISIT/ INSPECTION COMPLETED:	02:45 PM

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Licensing Program Analyst (LPA), Mayra Cota, conducted an unannounced annual visit today. LPA met with Alisa Dean, Executive Director, and the reason for the visit was explained.

The facility is licensed to serve adults age range 60 and over; approved for 150 non-ambulatory of which 20 can be bedridden; Hospice waiver approved for 20 residents. The facility is operating within the scope of its license. The facility is in a residential area of Temple City and consists of (89) resident rooms with bathroom included in each room, main entry lobby/lounge, (5) administrative office, medication room, kitchen, (2) dining rooms, (2) patios/courtyards, movie theater room, activities room, (6) staff/visitor restrooms, garden room/TV room, beauty parlor, staff break room, (2) maintenance/housekeeping storage rooms, laundry room, record room and parking lot.

During today’s visit, LPA toured the physical plant. Facility was observed clean throughout. Hallways, walkways and exits are kept free of debris and obstructions. LPA inspected the common areas and randomly checked (10) resident rooms. Resident rooms have the required furniture, bedding, closet space and lighting. Bathrooms were observed clean and sanitary. Water temperature was tested in each bathroom and measured between 105.3 – 115.5 degrees F. which is within compliance range. Bathrooms have anti-slip mats and grab bars; however, shower side grab bar in room #143 and shower grab bar above faucet in room #112 are loose. Grabs bars were observed not properly bolted to the wall in both rooms. Call buttons in resident rooms were tested and working properly. Common areas have sufficient seating, and furniture is in good repair. There are no swimming pools or other bodies of water on the premises. Fire extinguishers were observed throughout the facility and are kept charged and operational. Fire extinguishers were last serviced on 8/21/2025. Laundry room is clean and appliances are operational. LPA also conducted interviews with (9) residents during the tour.

Due to time constraints, LPA Cota will return to complete the annual inspection. Deficiency noted during today’s visit and a Civil Penalty was assessed for $250 for Repeat Violation. Exit interview was conducted with Alisa Dean, Executive Director, and a copy of this report, 809-D, Appeal Rights and LIC 421FC was provided.

NAME OF LICENSING PROGRAM MANAGER: Wei Siew Ho
NAME OF LICENSING PROGRAM ANALYST: Mayra Cota
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 06/30/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/30/2026

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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California Health & Human Services Agency

California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:

Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.

Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)

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Document Has Been Signed on 06/30/2026 02:38 PM - It Cannot Be Edited

Created By: Mayra Cota On 06/30/2026 at 01:24 PM

Link to Parent Document Below:

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754

FACILITY NAME: SANTA ANITA ASSISTED LIVING	FACILITY NUMBER: 198603535
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 06/30/2026

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

87303(a)

Maintenance and Operation

(a) The facility shall be clean, safe, sanitary and in good repair at all times. Maintenance shall include provision of maintenance services and procedures for the safety and well-being of residents, employees and visitors. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observations, the licensee did not comply with the section cited above in (2) out of (10) resident rooms inspected had loose shower grab bars. Shower side grab bar in room #143 and shower grab bar above faucet in room #112 are loose. Grabs bars observed not properly bolted to the wall, which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 07/07/2026
	Plan of Correction
1 2 3 4	Licensee/Director will send LPA photos of the repairs for the grab bars by POC due date.

Section Cited


	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

	Wei Siew Ho
NAME OF LICENSING PROGRAM MANAGER:

	Mayra Cota
NAME OF LICENSING PROGRAM ANALYST:

LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 06/30/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/30/2026

LIC809 (FAS) - (06/04)

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