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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198603648
Report Date: 10/07/2024
Date Signed: 10/07/2024 06:00:12 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 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
10/03/2024 and conducted by Evaluator Bonnie Tao
COMPLAINT CONTROL NUMBER: 28-AS-20241003125735
FACILITY NAME:OMEO ARCADIA LIVINGFACILITY NUMBER:
198603648
ADMINISTRATOR:ZHANG, JINGFANGFACILITY TYPE:
740
ADDRESS:601 SUNSET BLVDTELEPHONE:
(323) 422-8030
CITY:ARCADIASTATE: CAZIP CODE:
91007
CAPACITY:99CENSUS: 80DATE:
10/07/2024
UNANNOUNCEDTIME BEGAN:
08:00 AM
MET WITH:Jennifer JingFang Zhang, administratorTIME COMPLETED:
12:00 PM
ALLEGATION(S):
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Facility is in disrepair.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Tao conducted an unannounced complaint investigation for the allegation listed above. LPA met Administrator, Jennifer Zhang and explained the purpose of today's complaint investigation visit.

The investigation consisted of the following: during the investigation visit, LPA obtained staff/resident roster, interviewed residents from resident#1 (R1) to resident#6 (R6), interviewed staff from staff#1 (S1) to staff #2 (S2), and conducted a physical plant.
The investigation revealed the following:

In regard of allegation the facility is in disrepair, it was alleged that the elevator that went to the third floor was not working. LPA interviewed residents and all six (6) residents stated the elevator to the third floor was out of services. (-continued on LIC9099C-)
Substantiated
Estimated Days of Completion:
NAME OF LICENSING PROGRAM MANAGER: Fernando Fierros
NAME OF LICENSING PROGRAM ANALYST: Bonnie Tao
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 10/07/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/07/2024
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 3
Control Number 28-AS-20241003125735
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION 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: OMEO ARCADIA LIVING
FACILITY NUMBER: 198603648
VISIT DATE: 10/07/2024
NARRATIVE
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All two (2) staff interviewed stated that elevator was not working. Staff interviews revealed that elevator was working for a day and out of services again in the past two weeks. Per record review, staff reported in the incident report dated 9/20/24 stating the elevator that went to the third floor was not working. Elevator company had come to repair that elevator; however, that elevator was not working today, 10/7/24. Thus, the facility was in disrepair.

Based on LPA's observations, record reviews and interviews conducted the preponderance of evidence standard has been met, therefore the above allegation is found SUBSTANTIATED.

Deficiencies are being cited according to California Code of Regulations, Title 22, Division 6, Chapter 8 on LIC 9099D.

An exit interview was conducted with Jennifer, administrator. A hard copy of this reports and appeal right were provided.
NAME OF LICENSING PROGRAM MANAGER: Fernando Fierros
NAME OF LICENSING PROGRAM ANALYST: Bonnie Tao
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 10/07/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/07/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 28-AS-20241003125735
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION 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: OMEO ARCADIA LIVING
FACILITY NUMBER: 198603648
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/07/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
10/11/2024
Section Cited
CCR
87303(a)
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The facility shall be clean, safe, sanitary and in good repair at all times.

The requirement is not met by evidence of:
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Licensee agreed to provide the repair the elevator that goes to the third floor by POC due date. Licensee provide the proof of the repair to Licensing.
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The facility elevator that goes to the third floor is not operational. Based on interviews and observation, the Administrator did not comply with the section cited above which poses a potential health, safety or personal rights risk to persons in care.
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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.
NAME OF LICENSING PROGRAM MANAGER: Fernando Fierros
NAME OF LICENSING PROGRAM ANALYST: Bonnie Tao
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 10/07/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/07/2024
LIC9099 (FAS) - (06/04)
Page: 3 of 3