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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198603821
Report Date: 09/09/2025
Date Signed: 09/09/2025 12:36:29 PM

Document Has Been Signed on 09/09/2025 12:36 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
MONTEREY PARK ASC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754
FACILITY NAME:ARCADIA LIVINGFACILITY NUMBER:
198603821
ADMINISTRATOR/
DIRECTOR:		ZHANG, JINFANGFACILITY TYPE:
740
ADDRESS:601 SUNSET BLVDTELEPHONE:
(888) 218-8921
CITY:ARCADIASTATE: CAZIP CODE:
91007
CAPACITY: 99CENSUS: 88DATE:
09/09/2025
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:14 AM
MET WITH:Andy Zhang-LicenseeTIME VISIT/
INSPECTION COMPLETED:
12:30 PM
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Licensing Program Analyst (LPA) Sanjay Vaid conducted an announced visit with Administrator Jennifer Zhang, Licensee Andy Zhang and CEO Ben Zhang. The purpose of the visit was to inspect the facility for Change of Ownership.

An application was submitted to CCLD on 9/16/24, for a Change of Ownership of a Residential Care Facility for the Elderly. The requested capacity of 99 residents, (0) ambulatory, (99) non-ambulatory and (0) may be bedridden. Hospice Waiver request was submitted for up to Fifteen (15) residents.

The facility is currently operating under Facility #198603648

Structure/Physical Plant: The facility is a large 3 story structure with 90 bedrooms, 86 bathrooms, 1 TV room, an administrative office, a restaurant style kitchen, two laundry rooms, a janitor storage room, and two elevators. The facility has a gas fireplace in the activity room with a metal screen cover and is inaccessible to residents. There is a large, covered patio area, with a fishpond on the premises. There is an underground floor for staff and visitor parking. Rooms #234,#235 and #126 were repaired and final permits were issued by City of Arcadia on 9/8/2025.

Accommodations: Adequate accommodations observed throughout facility.

Lighting: Sufficient Lighting throughout.

Hallway and Doorways: Free and clean of obstruction and debris.
continued 809C.........
NAME OF LICENSING PROGRAM MANAGER: Fernando Fierros
NAME OF LICENSING PROGRAM ANALYST: Sanjay Vaid
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 09/09/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/09/2025
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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California Health & Human Services Agency
California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:
  • Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.
  • Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)
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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK ASC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754
FACILITY NAME: ARCADIA LIVING
FACILITY NUMBER: 198603821
VISIT DATE: 09/09/2025
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Residents Rooms: Bedrooms #307, #305, #206, #234, #235 and #105 were observed. Most bedrooms are equipped with overhead lighting, chair, night stand, lamp in addition to overhead lighting, large drawer, and closet space. Bedrooms have attached bathrooms.

Bathrooms: Bathrooms observed to meet Title 22 requirements.

Linens & Hygiene Supplies: Required linen/supplies which include, pillowcase, fitted sheet, blankets, bedspreads. Mattress pads were observed.

Emergency Phone Numbers, Exit Plan & Menu: Facility has a working phone landline. There are two (2) cordless phones for resident’s use.

Food Service: All food and adequate utensils such as, dishes, cups, bowls and plates were observed. Knives, cutlery and other sharps inaccessible to residents will be kept in a kitchen inaccessible to residents. Residents diets are posted in kitchen, soft, mechanical, diabetic, low sodium. Menu is updated monthly. Food is ordered twice weekly.

Smoke Detectors & Fire Extinguishers: Facility has Fire Panel that notifies Fire Department when set off. Smoke detectors and also carbon monoxide detectors observed, throughout resident rooms and common areas. Tested and operational. Fire Extinguisher(s) fully charged and up to date 11/27/2024.

Appliances: Kitchen stove burners and oven operational. Microwave, washers and dryers are operational.

Toxins: Locked/stored for staff use only.

Hot Water Temperature: Measured and within Title 22 Regulations

Medications, First-Aid Kit & Book: Medications central storage location inaccessible to residents was observed. First aid kit inspected, and all required items observed.

Residents & Staff Files: Facility has a locked areas for resident and staff files.

continued 809C.............
NAME OF LICENSING PROGRAM MANAGER: Fernando Fierros
NAME OF LICENSING PROGRAM ANALYST: Sanjay Vaid
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 09/09/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/09/2025
LIC809 (FAS) - (06/04)
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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK ASC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754
FACILITY NAME: ARCADIA LIVING
FACILITY NUMBER: 198603821
VISIT DATE: 09/09/2025
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Reading Material, Games, Equipment & Materials, Postings: The facility has activity supplies, and an activities calendar posted. Required wall postings observed.

Fire clearance: Fire clearance was approved on 07/01/25.

Comp III was conducted at the Pre-Licensing visit, information provided about how to operate the facility within substantial compliance.

An exit interview was conducted, and a copy of this report has been furnished to the applicant. Accordingly, LPA will submit a copy of this facility evaluation report to the Central Applications Bureau (CAB) for review. If the applicant has questions regarding the status of the application, they have been instructed to communicate with the CAB Analyst assigned to their application.

The plant inspection has passed.
NAME OF LICENSING PROGRAM MANAGER: Fernando Fierros
NAME OF LICENSING PROGRAM ANALYST: Sanjay Vaid
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 09/09/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/09/2025
LIC809 (FAS) - (06/04)
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