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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198603648
Report Date: 07/01/2025
Date Signed: 07/01/2025 01:22:28 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
GREATER LA AC/SC, 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
06/24/2025 and conducted by Evaluator Bennette Pena
PUBLIC
COMPLAINT CONTROL NUMBER: 28-AS-20250624153633
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: 81DATE:
07/01/2025
UNANNOUNCEDTIME BEGAN:
09:33 AM
MET WITH:Jennifer Lan - Administrator/Wellness Director
Lucy Alonso - Med Tech		TIME COMPLETED:
01:30 PM
ALLEGATION(S):
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Staff did not prevent resident(s) nap from being disrupted.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Bennette Pena conducted an unannounced initial complaint visit to investigate the above allegation. LPA met with Lucy Alonso, Med Tech and explained the purpose of
the visit. Shortly after, Jennifer Lan, Admiinistrator/Wellness Director arrived and assisted LPA with the investigation.
The investigation consisted of the following: LPA obtained copies of the staff & resident rosters, incident reports and service reports/work invoices (ServPro and HHKC Development), Resident #1 (R1) - Resident #3 (R3) pertinent files such as: Identification/Emergency Information, Admission Agreement, Preplacement Appraisal, Physician's report and Personal Rights. LPA interviewed Staff #1 (S1) - Staff #3 (S3) and Resident #1 (R1) - Resident #8 (R8).
The investigation revealed the following:
In regards to the allegation: "Staff did not prevent resident(s) nap from being disrupted." It is alleged that there was a leak in the hallway a week or 2 ago, and the walls were cut to replace the pipes and during the construction process it was disrupting residents nap time. (3) of (3) staff interviewed stated that a pipe burst in a residents room and staff called the maintenance and contacted a service company to fix the problem. ***CONTINUED ON LIC9099-C***
Substantiated
Estimated Days of Completion:
NAME OF LICENSING PROGRAM MANAGER: David Sicairos
NAME OF LICENSING PROGRAM ANALYST: Bennette Pena
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 07/01/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/01/2025
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-20250624153633
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		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: OMEO ARCADIA LIVING
FACILITY NUMBER: 198603648
VISIT DATE: 07/01/2025
NARRATIVE
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Mold was discovered by the cleaning/restoration company in various sections and rooms of the building, and part of the mediation included putting dehumidifiers in many residents rooms to prevent mold. (6) out of (8) residents interviewed corroborated the allegation and stated that the noise from the construction and machines/dehumidifiers prevented them from sleeping or napping. Some residents interviewed stated that the dehumidifiers were loud and put out a lot of heat which made their rooms hot and made it harder for them to sleep. Interviewed residents also indicated that the dehumidifiers placed in their rooms ran continuously for approximately a week or so. LPA observed that the walls in the 2nd floor hallway and the resident's room are still under construction but there were no safety precaution signs or that work is in progress.

Based on LPA's observation, interviews, and record reviews, the preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED. Deficiency cited on the attached LIC 9099D.

An exit interview was conducted, and a copy of this report was provided to Lucy Alonso, Med Tech along with the Appeals Rights.
NAME OF LICENSING PROGRAM MANAGER: David Sicairos
NAME OF LICENSING PROGRAM ANALYST: Bennette Pena
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 07/01/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/01/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 28-AS-20250624153633
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		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: OMEO ARCADIA LIVING
FACILITY NUMBER: 198603648
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/01/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
07/11/2025
Section Cited
CCR
87468.1(a)(3)
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87468.1 Personal Rights of Residents in All Facilities..(a) Residents in all residential care facilities for the elderly shall .....(3) To be free from punishment, humiliation, intimidation, abuse, or other actions of a punitive nature, such as.. interfering with daily living functions such as eating, sleeping, or elimination.
This requirement is not met as evidenced by:
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Licensee/Administrator to ensure that residents are accorded safe, healthful and comfortable accommodations and to submit a plan to avoid interfering with residents activities of daily living functions such as sleeping when a construction/renovation is ongoing.
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Based on observation, interviews, records review, the licensee did not comply with the section cited above in which the mold mediation and construction interfered with the residents nap and sleep time which poses a potential health and safety concern to residents in care.
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Administrator to submit the plan to CCL/LPA by POC due date.
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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: David Sicairos
NAME OF LICENSING PROGRAM ANALYST: Bennette Pena
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 07/01/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/01/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 3