Arcadia Living

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Blanca Gonzalez conducted an unannounced required annual visit. LPA was greeted by staff, and the purpose of the visit was explained. Administrator Jennifer Lan arrived shortly after to assist. The facility is a large 3 story structure located in the city of Arcadia. The structure consists of a lobby, 90 bedrooms, 86 bathrooms, an activity room, an administrative office, a commercial kitchen, dining area, two laundry rooms, and two elevators. Hospice waiver in place for (15). LPA utilized the Compliance and Regulatory Enforcement (CARE) tools for the visit today and observed the following: Operational Requirements: Facility is operating within the limitations of their license. There are currently seven (7) residents receiving Hospice services. LPA observed current liability insurance. Staffing: Staff sufficient in number and competent to meet resident needs. Personnel Records- training: LPA reviewed six (6) staff files. Personnel records are maintained at the facility for administrator and each staff member. Two (2) out of six (6) records reviewed did not contain Health Screening with TB clearance. Deficiency cited. One (1) out of six (6) records reviewed did not contain fingerprint clearance and association to the facility. Deficiency cited. Civil penalties issued for background check. continued on LIC 809C Planned Activities: Calendar of activities was posted in the hall and in the elevators. LPA observed music playing for residents and residents engaging in a group activity in the activity room. Physical Plant/Environmental Safety: During facility tour, LPA observed all common areas in good repair. A total of six (6) resident rooms were selected at random for inspection. Each room contained the required furnishing, with sufficient lighting, and bedding supplies. Linens were observed to be clean and in good repair. Water temperature was tested in each resident bathroom and measured between 115.3°F – 116.8° F, which is within the required 105°-120° F. Bathrooms were observed with grab bars and non-slip mats or flooring. Disinfectants, cleaning solutions, and sharps are locked and not left unattended. Passageways, hallways, stairways are clear of debris and obstructions. Facility has a fire sprinkler system throughout. Fire extinguishers were observed throughout the facility. Elevators were observed working. There was an evacuation chair in the stairwell. 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. Resident Rights/Information: License, Ombudsman, and personal rights posters were posted in the hallway. "Let us no" (PUB 475) was not posted. Administrator posted at time of visit. Food Services: LPA toured the commercial kitchen and observed good quality/commercial food supplies for at least 2 days of perishables and 7 days of non-perishables. All kitchen areas observed clean and free of litter, rodents, vermin and insects. Soaps, detergents, cleaning compounds or similar substances stored in areas separate from food supplies. Staff were observed practicing hygiene and infection prevention. A list for residents with modified diets was observed. Incidental Medical and Dental: Medications were observed stored in medication carts in each medication room. LPA reviewed medication for three (3) residents. Facility uses EMAR for documentation, recently implementing the August Health program. continued page 3 Resident Records/Incident Reports: LPA reviewed five (5) residents files. Files maintained at the facility and each contained admission agreement, medical assessment with TB clearance, pre-appraisal and resident care plan. Disaster Preparedness: Emergency drills are conducted quarterly; last emergency drill was conducted on 08/02/2026. Per California Code of Regulations, Title 22, and California Health and Safety Code, the deficiencies observed today are documented on the attached LIC809D page. Civil penalties in the amount of $500 are being issued for Background Check. Exit interview was conducted and a copy of this report, civil penalties and appeal rights were provided to Administrator Jennifer Lan.the state’s words, verbatim · CDSS document, Aug 24, 2026

Allegation investigated: Resident eloped due to staff neglect Licensee failed to respond promptly and appropriately to communications from the resident’s representative

Licensing Program Analyst (LPA) Vaid conducted complaint investigation to the facility and met with Administrator Jennifer Lan and explained the reason for the visit. LPA and Administrator toured the facility and did not observe any health and safety concerns. LPA requested , received and reviewed the following documents: staff and resident roster, Resident 1 face sheet, physicians medication orders, and physician’s reports. Interviewed staff and residents. Regarding the allegation: Resident eloped due to staff neglect. It is alleged that due to staff neglect resident eloped from the facility. Four of four staff deny this, according to staff residents are monitored constantly by assigned caregivers throughout the shift and staff stated been monitoring R1 more frequently due to past elopements. Residents that require assistance to leave facility have pictures posted in front office to alert staff of residents unable to leave the facility without assistance. Staff stated having observed resident attempting to leave the facility after R1’s family had left and stopped the resident from leaving the facility and brought the resident back to their room without incident. CONTINUED ON 9099C................ Unsubstantiated Staff stated informing the family of the incident each time after family’s visit and spoke with R1’s health agent (family)about placing R1 in another facility due to decline in R1’s health condition. Eight of eight residents interviewed could not corroborate this allegation, residents do not know about this incident happening at the facility. According to W1, R1 had two eloping incidents which have been investigated and resolved in complaint number 28-AS-20260218123711. According to W2, W1 had inquired about the elopement incident earlier this year, and according to W2, R1 has not had an elopement incident since February 2026. Based on interviews and records review, although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is unsubstantiated. Regarding the allegation: Licensee failed to respond promptly and appropriately to communications from the resident’s representative. It is alleged that the facility failed to promptly and appropriately communicate incidents to residents’ family. Four of four staff deny this, according to staff each time an incident occurs no matter how small the incident is, the staff will notify licensing and residents families. Staff acknowledged that R1 has eloped twice in past year and the staff monitor R1 more frequently. According to W2, staff have spoken to the family about R1’s declining health conditions and requiring higher level of care and staff has alerted W2 each time R1 has had an elopement in the past year. Family is aware of two elopement incidents, W2 stated not having been informed about R1 eloping recently. According to the complaint, W1 was providing R1’s family with placement considerations after R1’s second elopement and this was addressed by licensing in complaint 28-AS-20260218123711. R1's family stated they have been constantly informed about R1's health and related conditions but not about any recent elopement. Based on records review and interviews conducted, although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is unsubstantiated. Exit interview was conducted with and copy of this report was provided to Administrator Jennifer Lan.the state’s words, verbatim · CDSS document, May 26, 2026 · control 28-AS-20260517192630

Allegation investigated: Staff did not prevent a resident from smoking inside of the facility.

Licensing Program Analyst (LPA) Vaid conducted initial investigation and met with Maritza Arizmendi, assistant to Administrator Jennifer Lan arrived shortly after and discussed the above-mentioned allegation. LPA Vaid, administrator Lan and S2 toured the facility and did not observe any health and safety concerns. LPA Vaid requested, obtained and reviewed relevant resident and facility documents, interviewed staff and residents. The investigation revealed the following: Regarding the allegation: Staff did not prevent a resident from smoking inside of the facility. It is alleged that R2 smokes in their room and staff does not stop R2 from smoking inside the facility resident room. CONTINUED ON 9099C................ Unsubstantiated Four of four staff interviewed denied this, staff stated there are no residents smoking in the facility rooms, staff making routine rounds every two hours have not smelt cigarette smoke, have not observed ashes or cigarette butts in the residents’ room while preforming housekeeping duties. There is a designated smoking area for the residents and visitors. Staff are instructed to smoke off campus. S1 stated having advised R1 to notify staff whenever the smell of cigarettes is noticed, even in the late or early morning hours: anytime. During the tour, LPA Vaid observed smoke /fire alarms visibly flashing in each residents rooms inspected. Staff stated the smoke/ carbon monoxide alarms are hardwired. S1 stated the 'no smoking' rules are enforced. R1 did not have oxygen tank signs on the their door. Rooms with oxygen in use were observed with signs-'oxygen in use' on residents doors. Seven of eight residents interviewed could not corroborate this allegation. Residents stated not having smelled cigarette smoke on the third floor of the building or anywhere in the facility common areas. During tour of the facility and third floor LPA Vaid did not observe the smell of cigarette smoke in R1’s and R2’s rooms. LPA Vaid did not observe smell, ashes or cigarette butts in R2’s waste baskets. Based on interviews and observations of no cigarette smoke smell, although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is unsubstantiated. Exit interview was conducted and copy of this report is provided to Administrator Jennifer Lan.the state’s words, verbatim · CDSS document, May 7, 2026 · control 28-AS-20260429085846

Allegation investigated: Staff did not provide adequate supervision resulting in resident eloping

Licensing Program Analyst (LPA) Vaid conducted initial 10-day unannounced visit to investigate the above mentioned allegation. LPA was met by Administrator -Jennifer Zhang and the purpose of the visit was discussed. The investigation consists of: LPA Vaid requested, obtained and reviewed staff roster, resident roster, front desk staff schedule. LPA Vaid 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. LPA Vaid interviewed staff and residents. The investigation revealed the following: Staff did not provide adequate supervision resulting in resident eloping. It was alleged that the facility staff did not supervise and monitor R1 which resulted in R1 leaving the facility through the front entrance and going missing. CONTINUED ON 9099C................... Substantiated 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 02/12/26 R1 left the facility without the knowledge of staff and did not return until off-duty staff S2 observed R1 wandering in the local market at 4pm and notified the facility staff, law enforcement were notified. The facility staff and law enforcement brought R1 back to the facility at 510pm, conducted body check for injuries. No injuries to R1’s person. No Police Report was made. Last time staff observed R1 was during lunch when R1 was escorted back to their room. S4 was not aware of residents' elopement until the facility was notified and search for resident was announced. S4 had left the front desk to collect copies from the printer and did not observed resident leaving the facility unassisted. 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.the state’s words, verbatim · CDSS document, Feb 23, 2026 · control 28-AS-20260218123711

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87411(a) · Plan of correction due date: Mar 2, 2026

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: 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.the state’s words, verbatim · CDSS document, Feb 23, 2026

Plan of correction: 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 03/02/2026. Develop plan to assign staff and to monitor residents who are unable to leave the facility. Submit weekly LIC 500 for month of March 2026.

Allegation investigated: Facility staff handled resident in an aggressive manner, resulting in bruises.

Licensing Program Analyst (LPA) Cynthia Chan conducted a subsequent visit regarding the allegation above. LPA met with Administrator Jennifer Zhang and explained the purpose of the visit. The investigation consisted of the following: On 10/31/25, LPA S. Vaid conducted the initial visit and obtained the staff roster, resident roster, and documents for Resident #1 (R1) such as the face-sheet, physicians report, preplacement, medication list, needs and services plan. Some interviews were held with the residents and staff. On 1/5/26, LPA Cynthia Chan interviewed three (3) staff and one (1) resident. During the visit today, LPA Chan interviewed seven (7) residents. Additional staff interviews were held via telephone. Unsubstantiated The investigation revealed the following: Allegation - Facility staff handled resident in an aggressive manner, resulting in bruises. It is alleged that two staff were aggressive with Resident #1 (R1) while trying to get the resident out of bed and after informing staff that R1 did not want to shower. Per the administrator, on 10/29/25, she was made aware of the bruises on R1. The police came out the following day and spoke to residents and staff. The case was closed as there was no evidence of abuse or staff handling resident roughly. Staff interviewed stated that they have observed bruises on R1 when resident moved in September 2025. LPA obtained copies of the body check forms which indicated the areas where redness/bruises were found. Per staff, there are normally two caregivers assisting R1 during showers. Staff have not observed any caregivers handling the residents roughly. Staff stated that R1 gets up on own and could have hit the arm on surrounding objects which caused the bruising. Staff also stated that they receive training on how to properly lift/assist the residents to prevent bruising. LPA interviewed a total of eight (8) residents. R1 stated that caregivers have been rough with the resident, but could not provide staff names or specific details. The other seven (7) residents have not observed any staff being aggressive with residents. The residents, who need assistance with dressing and/or showering, stated the staff handle them carefully and have not caused any bruises. Based on the information gathered, there is insufficient evidence to prove that the bruises were caused by staff being aggressive with the resident. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur; therefore, the allegation is UNSUBSTANTIATED. An exit interview was conducted with the administrator. A copy of this report, along with the appeal rights, was provided.the state’s words, verbatim · CDSS document, Jan 6, 2026 · control 28-AS-20251030101928

Allegation investigated: Staff does not provide adequate supervision resulting in resident wandering away from facility.

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 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.the state’s words, verbatim · CDSS document, Oct 7, 2025 · control 28-AS-20251002081806

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87411(a) · Plan of correction due date: Sep 24, 2025

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: 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.the state’s words, verbatim · CDSS document, Oct 7, 2025

Plan of correction: 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.

Type of visit: Prelicensing

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......... 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............. 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.the state’s words, verbatim · CDSS document, Sep 9, 2025

Type of visit: Prelicensing

Licensing Program Analyst (LPA) Sanjay Vaid conducted an announced visit with applicant Jennifer Zhang. The purpose of the visit was to conduct the CHOW visit. 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 The physical plant inspection could not continue today, due to renovation being made at the facility after a water pipe broke and flooded the three residents rooms. Rooms 234,235 and 126 have water damage. Pre-licensing will be rescheduled for another time. The licensees must have the repairs to the three residents rooms and common areas completed before pre-licensing can be completed. Licensee must be present during pre-inspection. Administrator Jennifer Zhang was given copy of this report.the state’s words, verbatim · CDSS document, Jul 14, 2025

Type of visit: Office

Facility Type: RCFE Application Type: CHOW Capacity: 99 Census (if any clients in care): 82 Interview Method: Telephone interview On 6/20/2025, applicant/administrator participated in COMP II. Identification of the applicant and administrator was verified through interview questions based on photo ID and other identifying personal information. During COMP II, applicant and administrator confirmed that they have read and understand community care facility licensing laws included in the Health and Safety Codes and the California Code of Regulations Title 22. Signed LIC 809 with copy of photo ID have been obtained. During COMP II, CAB analyst confirmed Applicant/Administrator’s understanding of following areas: 1. Facility operation: License type, client/resident populations, and program 2. Admission Policies 3. Staffing requirements & Training 4. Restrictive/Prohibited Health Conditions 5. General provisions 6. Emergency Preparedness 7. Complaints & Reporting 8. Pre-licensing readinessthe state’s words, verbatim · CDSS document, Jun 20, 2025