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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 191593145
Report Date: 03/16/2023
Date Signed: 03/16/2023 10:39:40 AM

Document Has Been Signed on 03/16/2023 10:39 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
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: 23DATE:
03/16/2023
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Licensee Stanley Kaniel TIME COMPLETED:
10:45 AM
NARRATIVE
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On 3/16/2023 at 10:43 a.m., Licensing Program Analyst (LPA) Jewel Baptiste conducted an unannounced plan of correction (POC) visit to the facility. Upon arrival, LPA met with Licensee Stanley Kaniel and explained the reason for the visit.

During the visit on 2/21/2023, LPA observed the hot water temperature measured at 149.3- 149.9 degrees F. in room #7, #13, and #14. During the visit on 3/10/2023, LPA observed the hot water temperature in room #7, 135.5 in room #14, and in room #13 the hot water faucet is not operational. LPA provided n extension to have the water temperature repaired by 3/13/2023.

During today's visit, LPA observed the hot water temperature measured at 124.5 in room #7, 123.0 in room #14, and in room #13 the hot water faucet is not operational. Licensee stated the facility will need a new hot water heater.

Civil penalties cited on LIC421FC/ deficiencies were cited on LIC 809-D/ Exit Interview Conducted / Appeal


Rights Provided / A Copy of the Report Issued.
SUPERVISORS NAME: Lisa Hicks
LICENSING EVALUATOR NAME: Jewel Baptiste
LICENSING EVALUATOR SIGNATURE: DATE: 03/16/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/16/2023
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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Document Has Been Signed on 03/16/2023 10:39 AM - It Cannot Be Edited


Created By: Jewel Baptiste On 03/16/2023 at 08:11 AM
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: 03/16/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
03/23/2023
Section Cited
CCR
80088(e)(1)

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80088(e)(1) Furniture, Fixtures, Equipment, and supplies. 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).
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The administrator will ensure the hot water temperature in all bathrooms are within title 22 regulations, and will send the 7 days hot waterlog via email to LPA by 3/23/23.
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This requirement is not met as evidenced by:
Based on observations LPA tested water temperature in Room#7, 13 and 14. The water temperature either was not working or measured between 149.3-149.9, which poses a potential health and safety, personal rights risk to residents in care.
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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.
SUPERVISOR'S NAME:Lisa Hicks
LICENSING EVALUATOR NAME:Jewel Baptiste
LICENSING EVALUATOR SIGNATURE:
DATE: 03/16/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/16/2023


LIC809 (FAS) - (06/04)
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