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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198603535
Report Date: 08/27/2026
Date Signed: 08/27/2026 03:39:17 PM

Document Has Been Signed on 08/27/2026 03:39 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 LIVINGFACILITY NUMBER:
198603535
ADMINISTRATOR/
DIRECTOR:		ALISA DEANFACILITY TYPE:
740
ADDRESS:5600 GRACEWOOD AVENUETELEPHONE:
(626) 442-8410
CITY:TEMPLE CITYSTATE: CAZIP CODE:
91780
CAPACITY: 150CENSUS: 145DATE:
08/27/2026
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:45 AM
MET WITH:Alisa Dean, Executive DirectorTIME VISIT/
INSPECTION COMPLETED:
03:50 PM
NARRATIVE
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***This is a corrected version of the original report. The purpose of the report is to re-issue citation issued on 7/9/2026 which was dismissed by the department. On today's visit LPA is issuing a new citation for section 87303(a). Also, missing information on the narrative of LIC 809 has been added regarding details of why citations were issued on 7/9/2026. LPA met with Alisa Dean, Executive Director, and the reason for the visit was explained.

Licensing Program Analysts (LPAs), Mayra Cota and Nune Margaryan, conducted an unannounced annual continuation visit on 7/9/2026. The following observations were made on 7/9/2026.

The facility is licensed for 150 non-ambulatory residents, ages 60 and over, of which (20) may be bedridden. There is a hospice waiver approved for (20) residents. Currently, there are (12) residents receiving Hospice services. 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.

Furniture throughout the facility was observed clean and in good condition. Facility ramps were free of obstruction; however, stacked boxes with incontinent care and cleaning supplies were observed in front of the west doorway/exit unattended and obstructing the exit/entry way. Also, outdoor areas accessible through residents' rooms around the facility and back lot had broken furniture, piles of old mattresses, broken bedframes, wheelchairs, walkers, commodes/toilets, wooden pallets, cardboard boxes and AC filters. Shaded areas are available in the courtyard and smoking section in the secondary patio is kept clean. Outdoor furniture was observed to be in good repair and sufficient seating is available. ***Continues on LIC 809-C***

Wei Siew Ho
Mayra Cota
DATE: 08/27/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/27/2026
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 4
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION 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: SANTA ANITA ASSISTED LIVING
FACILITY NUMBER: 198603535
VISIT DATE: 08/27/2026
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LPAs observed signal/auditory devices on (4) exit doors. Staff indicated that the facility recently installed the auditory devices; however, they are non-operational. LPAs observed the auditory devices to be non-operational during visit.

R9's room was observed to have scissors and tweezers and outdoor passageway in their room had gardening tools, insect repellant and aerosol paint cans. LPAs also observed Tylenol (Acetaminophen) 500 mg. tablets, Vitamin C 500 mg tablets, and Allergy Relief nasal spray in the room of R1 who cannot manage their own medication, according to staff input.

Kitchen was inspected and observed to have sufficient 2-day perishable and 7-day non-perishable supply of food. Food was observed to be kept properly stored and within expiration limits. Refrigerators and freezers maintain proper temperatures. Extra supply of food and water is kept in a secondary pantry. Serving trays were observed with cracks on the edges and baking trays had layers of burnt grease. Also, dishwashing area and equipment were observed unclean and hot water in the faucet was observed running and not fixed.

Appliances in the laundry room were observed operational; however, the laundry room was observed unlocked and bleach and laundry detergent were kept accessible to residents.

LPAs conducted inspection of the medication room during visit. Medication was observed centrally stored. During review of medication, LPAs observed that Resident 4 (R4) had a prescription for Acetaminophen 500 mg tablets (PRN), quantity 180, prescribed on 5/4/2026. LPAs observed that 60 tablets were missing from the medication supply. Staff indicated that R4 had recently left the facility for an extended period and took the Acetaminophen 500 mg tablets (PRN) and returned with the number of tablets observed by LPAs during medication review. Staff were not able to provide proof that inventory of the medication was conducted before and after R4 returned from extended leave to account for the missing (60) tablets. Staff were unable to determine the amount of tablets that were used by R4 during their leave.

LPAs reviewed (6) staff and (10) resident files. Staff files contain background clearances, health screenings and training documents. Physician orders for half bedrails for (2) residents whose room was inspected during visit, were not present in the file. Staff were unable to provide them during visit.

Above deficiencies were observed and noted on LIC 809Ds on 7/9/2026.

Exit interview was conducted with Alisa Dean, Executive Director, and a copy of this report,new citation on LIC 809D and Appeal Rights, was provided.

NAME OF LICENSING PROGRAM MANAGER: Wei Siew Ho
NAME OF LICENSING PROGRAM ANALYST: Mayra Cota
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 08/27/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/27/2026
LIC809 (FAS) - (06/04)
Page: 3 of 4
Document Has Been Signed on 08/27/2026 03:39 PM - It Cannot Be Edited


Created By: Mayra Cota On 08/27/2026 at 02:43 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: 08/27/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
09/04/2026
Section Cited
CCR
87303(a)

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87303 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.
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Licensee/Administrator will ensure that the auditory/signal system is working at all times. Licensee/Administrator will email proof of staff in-service and proof that the entire building's auditory/signal system and pendants were tested and are receiving the page within facility protocols response time by POC due date.
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This requirement is not met as evidenced by:

LPAs observed signal/auditory devices on (4) exit doors. Staff indicated that the facility recently installed the auditory devices; however, they are non-operational. LPAs observed the auditory devices to be non-operational during visit.
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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.
Wei Siew Ho
NAME OF LICENSING PROGRAM MANAGER:
Mayra Cota
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 08/27/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/27/2026


LIC809 (FAS) - (06/04)
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