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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198603550
Report Date: 10/29/2024
Date Signed: 02/14/2025 11:25:05 AM

Document Has Been Signed on 02/14/2025 11:25 AM - 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:WEST PARK SENIOR LIVINGFACILITY NUMBER:
198603550
ADMINISTRATOR/
DIRECTOR:		CRYSTENE CHARFACILITY TYPE:
740
ADDRESS:801 CYPRESS WAYTELEPHONE:
(909) 592-8844
CITY:SAN DIMASSTATE: CAZIP CODE:
91773
CAPACITY: 200CENSUS: 110DATE:
10/29/2024
TYPE OF VISIT:OfficeANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:30 AM
MET WITH:Crystene Char, Executive Director
Marlene Nelson, Director of Regulatory Compliance		TIME VISIT/
INSPECTION COMPLETED:
11:05 AM
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Licensing Program Analyst (LPA), Daniel Konishi, Licensing Program Managers (LPMs), David Sicairos and Fernando Fierros conducted a Virtual Office Meeting and met with West Park Senior Living Executive Director, Crystene Char, and Pacifica Senior Living Director of Regulatory Compliance, Marlene Nelson to discuss the de-licensing of the 7th floor.

During the meeting, the following was discussed:
  • How facility will not share any common areas including front lobby, elevator with the independent living residents.
  • Independent living to have its own private entrance/exit that is separate from the Assisted living.
  • Licensee to ensure that the Assisted Living and Independent Living maintain an approved fire clearance.
  • Licensee to submit the LIC200 Application along with fees for change of capacity (decrease).
  • Assisted living staff is not to be shared with Independent living staff.

Administrator will contact the local fire authority regarding independent residents using the stairwell for private entrance.

Administrator stated the licensee is not interested in operating as a Continuing Care Retirement Community (CCRC).

The department will follow up with the administrator regarding the request to de-license the 7th floor.

LPA Konishi will email the report to the Administrator for signature.
SUPERVISORS NAME: David Sicairos
LICENSING EVALUATOR NAME: Daniel Konishi
LICENSING EVALUATOR SIGNATURE: DATE: 10/29/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/29/2024
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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