198603968-4-22-2026-28-AS-SVAD-DTDKU7-20260422081215

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 198603968
Report Date: 04/21/2026
Date Signed: 04/22/2026 08:12:26 AM

Document Has Been Signed on 04/22/2026 08:12 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:	ASPIRIA RESIDENCE ARCADIA		FACILITY NUMBER:	198603968
ADMINISTRATOR/ DIRECTOR:	LABAO, MICHELLE		FACILITY TYPE:	740
ADDRESS:	342 W. PALM DR.		TELEPHONE:	(626) 252-0994
CITY:	ARCADIA	STATE: CA	ZIP CODE:	91007
CAPACITY: 6		CENSUS: 6	DATE:	04/21/2026
TYPE OF VISIT:	Prelicensing	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	08:41 AM
MET WITH:	MICHELLE LABAO, ADMINISTRATOR		TIME VISIT/ INSPECTION COMPLETED:	11:00 AM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	Licensing Program Analyst (LPA), Sanjay Vaid conducted an announced pre-licensing inspection. This is an Change of Ownership application applying for Residential Care for Elderly. LPAs met Michelle Labao, licensee applicants. The facility has a capacity of six (6). Its fire clearance is approved for: Age range 60 and over. Approved for Six (6) residents of which Two (2) may be non-ambulatory in rooms 5. Four (4) ambulatory. Zero (0) bedridden. Hospice waiver granted for Two (2). LPA observed six residents at the time of the visit. The facility has a Dementia Care Program. The applicants are a Limited Liability Corporation, Aspiria Residences Arcadia LLC. The facility was a single-story home with five (5) client’s bedrooms, four (4) bathrooms, two (2) living rooms, a kitchen, a dining room, an activity area at the patio, a laundry room and a detached garage. The facility was located in a residential neighborhood. This facility was granted fire clearance on 01/22/2026. Has dementia plan for residents. LPA conducted tour of the physical plant including the interior and exterior of the house including the garage. LPA observed the following: CONTINUED ON 809C.....................

NAME OF LICENSING PROGRAM MANAGER: Fernando Fierros
NAME OF LICENSING PROGRAM ANALYST: Sanjay Vaid
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 04/21/2026

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/21/2026

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: ASPIRIA RESIDENCE ARCADIA	FACILITY NUMBER: 198603968
	VISIT DATE: 04/21/2026

NARRATIVE

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Auditory device at the main entrance and exit doors are operable. Food storage and preparation areas were clean and in good repair. Cooking / kitchen appliances were operational. Food utensils and dining wares were sufficient for their capacity. Hot water was within 120 degrees Fahrenheit which was within Title 22 Regulation guidelines. The refrigerator was maintained at 36 degrees F. and the freezer was maintained at 0 degree F. Two days of perishable food and seven days of non-perishable food were available. Sharp tools and knives were stored in a locked cabinet in the kitchen. Cleaning supplies and poisons solutions are stored in a locked cabinet in the locked laundry room. Two fire extinguishers were fully charged which were located in the kitchen and hallway, last service date was 08/01/2025. Facility has central air and heating accommodations at 68 degrees F. Smoke and carbon monoxide detectors were operational and hard-wired to the local fire department. Linens supplies and personal hygiene supplies were adequate. Residents’ rooms were well furnished and in compliance.

Grab bars are maintained for each toilet, bathtub and shower. Non- skid mats are installed in bathtubs and showers. Doors, stairways and passageway were unobstructed. No firearms in facility. Telephone for residents was operational. Medication was centrally stored in a medication cabinet and inaccessible to residents. First aid supplies and manual were maintained. No pool or bodies of water at the facility. Outdoor activity area, supplies, shaded area, chairs were furnished and in compliance. Detached garage used as storage.

Administrator has had Criminal Background Clearance. Personnel Report / LIC 500 were prepared. Licensee applicant stated that the staff records/ files are updated when needed and more staff are hired. Administrator certificate expires 01/31/2027. A current disaster plan is maintained. All emergency shut-offs are located outside of the house. Auditory device at the main entrance and exit doors are operable.

Dementia: Knives, tools, sharp items are inaccessible to residents. No swimming pool and other bodies of water at the facility. Medication and toxic substances are inaccessible to residents. Outdoor facility space used for residents and leisure are completely enclosed by a fence with self-closing gates. Auditory devices to monitor exits were operable. Interior and exterior spaces available to permit residents to wander freely and safely.

Licensee stated having completed Component III with Central Applications Bureau (CAB) online.

A exit interview was conducted and a copy of this report was provided to Applicant, Michelle Labao. 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, s/he has been instructed to communicate with the CAB Analyst who assigned to his/her application.

NAME OF LICENSING PROGRAM MANAGER: Fernando Fierros
NAME OF LICENSING PROGRAM ANALYST: Sanjay Vaid
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 04/21/2026

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/21/2026

LIC809 (FAS) - (06/04)

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