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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198603550
Report Date: 03/27/2023
Date Signed: 03/27/2023 03:46:51 PM


Document Has Been Signed on 03/27/2023 03:46 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
GREATER LA AC/SC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754



FACILITY NAME:WEST PARK SENIOR LIVINGFACILITY NUMBER:
198603550
ADMINISTRATOR:IRBY, LORIFACILITY TYPE:
740
ADDRESS:801 CYPRESS WAYTELEPHONE:
(626) 339-5426
CITY:SAN DIMASSTATE: CAZIP CODE:
91773
CAPACITY:200CENSUS: 116DATE:
03/27/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
01:20 PM
MET WITH:Administrator IrbyTIME COMPLETED:
02:45 PM
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Licensing Program Analyst (LPA) Kimberly Ramirez and Erik Zaragoza conducted an unannounced case management visit stemming from initial 10-day complaint visit dated 07/22/21, conducted by LPA Wesley. Complaint was originally filed against Atria Rancho Park # 197801052 and assigned control number 28-AS-20210721085127. LPA Ramirez and Zaragoza requested and obtained a copy of West Park Senior Living’s current staff roster and current resident roster. LPAs will need to conduct a file review of Atria Rancho Park and West Park Senior Living to confirm change in licensee. LPAs may return to collect further documents and interviews based upon file review.
SUPERVISOR'S NAME: Tony VasalloTELEPHONE: (323) 981-3977
LICENSING EVALUATOR NAME: Kimberly RamirezTELEPHONE: (323) 981-3970
LICENSING EVALUATOR SIGNATURE:
DATE: 03/27/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/27/2023
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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