<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 191593145
Report Date: 02/21/2023
Date Signed: 02/21/2023 04:45:28 PM

Document Has Been Signed on 02/21/2023 04:45 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
CCLD Regional Office, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754
FACILITY NAME:RAMONA GUEST HOME - BELLFLOWERFACILITY NUMBER:
191593145
ADMINISTRATOR:KANIEL, STANLEYFACILITY TYPE:
735
ADDRESS:9555 RAMONA STTELEPHONE:
(562) 867-1002
CITY:BELLFLOWERSTATE: CAZIP CODE:
90706
CAPACITY: 29CENSUS: 22DATE:
02/21/2023
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
12:44 PM
MET WITH:Stanley Kaniel, Administrator TIME COMPLETED:
05:00 PM
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
On 2/21/2023 at 12:44 p.m., Licensing Program Analyst (LPA) Jewel Baptiste conducted an unannounced Case Management visit to ensure the licensee is in compliance with Title 22 regulations, and to follow up on physical plant deficiencies observed during the Annual Inspection conducted on 1/19/2023. The purpose of the visit was explained to Administrator Stanley Kaniel. A tour of the facility was conducted.

On 1/19/2023, during the Annual Inspection LPA observed a hole in the roof of room #9, all bedrooms missing proper curtain rods, all bedrooms contained broken closets, broken furniture located in the TV room, missing bed in room #2, roaches in room#2, debris on the side of building, floor tiles bedrooms and bathrooms were in disrepair, and bathrooms screens in disrepair.



On 2/6/2023 LPA received written notice from Lakewood Fire Department, stating the facility is now on Fire Watch due to the fire system being non-operational.

During the tour LPA observed the facility is actively making repairs, and requested more time to continue working on other repairs.
SUPERVISORS NAME: Lisa Hicks
LICENSING EVALUATOR NAME: Jewel Baptiste
LICENSING EVALUATOR SIGNATURE: DATE: 02/21/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/21/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 3
Document Has Been Signed on 02/21/2023 04:45 PM - It Cannot Be Edited


Created By: Jewel Baptiste On 02/21/2023 at 02:49 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754

FACILITY NAME: RAMONA GUEST HOME - BELLFLOWER
FACILITY NUMBER: 191593145

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/21/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
03/14/2023
Section Cited
CCR
80028(a)

1
2
3
4
5
6
7
80028 Fire Clearence Violations, including, but not limited to, overcapacity, ambulatory status, inoperable smoke alarms, and inoperable fire alarm systems. All facilities shall secure and maintain a fire clearance approved by the city or county fire department, the district providing protection services, or the State Fire Marshal.
This requirement is not met as evidenced by:
1
2
3
4
5
6
7
The facility will ensure a proper fire system is operational and in working order. The Facility will also ensure to complete POC for the fire department to be removed from fire watch.
8
9
10
11
12
13
14
Based on Lakewood Fire Inspector the facility will be placed on fire watch due to an inoperable fire system, which poses a potential health and safety, personal rights risk to residents in care.
8
9
10
11
12
13
14
In accordance with the California Health and Safety Code Section 1548(c), you are hereby notified that an immediate $500.00 civil penalty will be assessed.
Type B
03/03/2023
Section Cited
CCR80088(e)(1)

1
2
3
4
5
6
7
80088(e)(1) Furniture, Fixtures, Equipment and supplies.(1)Hot water temperature controls shall be maintained to automatically regulate temperature of hot water delivered to plumbing fixtures used by clients to attain a hot water temperature of not less than 105 degrees F (40.5 degrees C) and not more than 120 degrees F (48.8 degrees C).
1
2
3
4
5
6
7
The administrator will ensure the hot water temperature in all bathrooms are within title 22 regulations, and will send the 7 days hot water log via email to LPA by 3/03/23.
8
9
10
11
12
13
14
This requirement is not met as evidenced by:
Based on observations LPA tested water temperature in Room#7, 13 and 14. The water tempearture either was not working or measured between 149.3-149.9, which poses a potential health and safety, peraonal rights risk to residents in care.
8
9
10
11
12
13
14
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Lisa Hicks
LICENSING EVALUATOR NAME:Jewel Baptiste
LICENSING EVALUATOR SIGNATURE:
DATE: 02/21/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/21/2023


LIC809 (FAS) - (06/04)
Page: 3 of 3
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754
FACILITY NAME: RAMONA GUEST HOME - BELLFLOWER
FACILITY NUMBER: 191593145
VISIT DATE: 02/21/2023
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
26
27
28
29
30
31
32
OBSERVATIONS:

· LPA observed the hole in the roof of room #9 was patched.

· In room #2, LPA observed a new bed and dresser.

· All closet doors are operational.

· Homeless squatter has now been removed from the facility.

· The facility has 24hrs security guard.

· Licensee emailed LPA pest control invoice for roaches.

OBSERVED DEFICIENCY:

· Bathroom tiles are in disrepair- Administrator stated completion date; 3/21/2023.

· Some client’s bedrooms need curtains- Administrator stated completion date; 2/26/2023.

· Administrator Certificate - Administrator stated facility will have an active Administrator by completion date of; 3/10/2023.

· Couches are in disrepair- Facility will replaced by completion date; 3/7/2023.

· Hot water temperature measured between 149.3- 149.9, which is not within Title 22 regulations. Citation issued.

· Fire system nonoperational – Zero tolerance deficiency, therefore civil penalties assessed.

California Code of Regulation, Title 22 are being cited on the attached LIC809D and Civil Penalties assessed. Exit Interview Conducted with Licensee Stanley Kaniel / Appeal Rights Provided / A Copy of the Report Issued.

SUPERVISORS NAME: Lisa Hicks
LICENSING EVALUATOR NAME: Jewel Baptiste
LICENSING EVALUATOR SIGNATURE:

DATE: 02/21/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/21/2023
LIC809 (FAS) - (06/04)
Page: 2 of 3