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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198603821
Report Date: 10/07/2025
Date Signed: 10/07/2025 12:12:55 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK ASC, 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
10/02/2025 and conducted by Evaluator Sanjay Vaid
PUBLIC
COMPLAINT CONTROL NUMBER: 28-AS-20251002081806
FACILITY NAME:ARCADIA LIVINGFACILITY NUMBER:
198603821
ADMINISTRATOR:ZHANG, JINFANGFACILITY TYPE:
740
ADDRESS:601 SUNSET BLVDTELEPHONE:
(888) 218-8921
CITY:ARCADIASTATE: CAZIP CODE:
91007
CAPACITY:99CENSUS: 97DATE:
10/07/2025
UNANNOUNCEDTIME BEGAN:
08:54 AM
MET WITH:TIME COMPLETED:
01:00 PM
ALLEGATION(S):
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Staff does not provide adequate supervision resulting in resident wandering away from facility.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Vaid conducted 10-day unannounced visit to investigated the above mentioned allegation. LPA’s were met by Administrator -Jennifer Zhang and the purpose of the visit was discussed.
The investigation consists of: LPA’s requested, obtained and reviewed staff roster, resident roster. LPA also reviewed the file of R1 and obtained copies of the following documents; -Identification and Emergency Information, -Physician's Report, -Preplacement Appraisal Information, and -Unusual Incident/Injury Report. Staff schedules, residents signin/out logs, visitors sign-in/out logs for 9/24/25. LPA Vaid interviewed staff, residents and witness.
The investigation revealed the following: Staff does not provide adequate supervision resulting in resident wandering away from facility. It was alleged that the facility staff did not supervise and monitor R1 enough which resulted in R1 leaving the facility through the front entrance and going missing.

CONTINUED ON 9099C.................
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Fernando Fierros
LICENSING EVALUATOR NAME: Sanjay Vaid
LICENSING EVALUATOR SIGNATURE:

DATE: 10/07/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/07/2025
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-20251002081806
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION 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: 10/07/2025
NARRATIVE
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Review of R1's documents reveal that R1 has a medical diagnosis that requires staff supervise and monitor of R1, dated 5/17/24. Interviews with staff show that on 09/24/2025 R1 left the facility without the knowledge of staff and did not return until law enforcement and paramedics alerted the facility and brought R1 back to the facility. Last time staff observed R1 was during dinner time at 515pm, when R1 was escorted back to their room. Based on LPAs interviews which were conducted and record review, the preponderance of evidence standard has been met, therefore the above allegation is found to be substantiated. California Code of Regulations, (Title 22, Division & Chapter number), are being cited on the attached LIC 9099D.”)


Exit interview was conducted with Administrator Jennifer Zhang. Copy of reports LIC-9099, LIC-9099C, LIC-9099D and LIC 421IM along with appeals were provided.
SUPERVISORS NAME: Fernando Fierros
LICENSING EVALUATOR NAME: Sanjay Vaid
LICENSING EVALUATOR SIGNATURE:

DATE: 10/07/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/07/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 28-AS-20251002081806
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION 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
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/07/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
09/24/2025
Section Cited
CCR
87411(a)
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87411.Personnel Requirements-General. (a) Facility personnel shall at all times be sufficient in numbers, and competent to provide the services necessary to meet resident needs...

This was not met as evidenced by:
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Facility to provide in-service training to staff on the importance of supervision and monitoring of residents in the facility. Training Sign in sheet Will be provided to LPA by POC Due date 10/14/2025.
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Facility staff was not aware of R1 walking out of the facility. R1 was not supervised by staff. According to files, R1 is not able to leave the facility unassisted. This poses an immediate Health and Safety risk for residents in care and supervision.
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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.
SUPERVISORS NAME: Fernando Fierros
LICENSING EVALUATOR NAME: Sanjay Vaid
LICENSING EVALUATOR SIGNATURE:

DATE: 10/07/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/07/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 3