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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198603445
Report Date: 12/05/2024
Date Signed: 12/05/2024 04:37:41 PM

Document Has Been Signed on 12/05/2024 04:37 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
CCLD Regional Office, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754
FACILITY NAME:ARCADIAN, THEFACILITY NUMBER:
198603445
ADMINISTRATOR/
DIRECTOR:
BRYANNA M LUKEFACILITY TYPE:
740
ADDRESS:753 W DUARTE ROADTELEPHONE:
(626) 445-7981
CITY:ARCADIASTATE: CAZIP CODE:
91007
CAPACITY: 120CENSUS: 107DATE:
12/05/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:00 AM
MET WITH:Hardin Lin, DirectorTIME VISIT/
INSPECTION COMPLETED:
03:45 PM
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Licensing Program Analyst (LPA) Tao conducted an unannounced Case Management- Incident visit in response to resident#4 (R4) Incident Report, dated 09/09/24. The incident was regarding resident who jumped off the balcony. LPA explained the purpose of today's visit to Hardin Lin, Director, who assisted with this visit.

During today's visit LPA toured the facility, interviewed staff/residents/responsible party, conducted physical plant and reviewed R4's file. The incident report stated R4 jumped off the the balcony from resident's room. Per interviews with staff, it revealed that the facility investigated this incident and the resident was not sober at the moment of the incident. Per interviews of residents, residents indicated staff did not neglect residents while in care. Per responsible party interview, R4 was not sober and thought resident could go to Mar for lunch after jumping off the balcony. Responsible party indicated that incident was resident's fault. Police came to investigate. (no report# was provided.) LPA did not observe nor identify signs of neglect, abuse or other immediate health and safety threats.

LPA obtained copies of the following documents:
· Staff / Resident roster
· R4’s Identification/Emergency Contact Information (facesheet)
· Unusual Incident Report
· Physician Report

No deficiencies were observed and cited during this visit. Exit interview held and a copy of the report was provided.
SUPERVISORS NAME: Fernando Fierros
LICENSING EVALUATOR NAME: Bonnie Tao
LICENSING EVALUATOR SIGNATURE: DATE: 12/05/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/05/2024
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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