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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 191593145
Report Date: 04/27/2023
Date Signed: 04/27/2023 02:53:37 PM

Document Has Been Signed on 04/27/2023 02:53 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: 23DATE:
04/27/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
12:30 PM
MET WITH:Licensee Stanley KanielTIME COMPLETED:
03:18 PM
NARRATIVE
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On 4/27/2023 at 12:30 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. The purpose of the visit was explained to Licensee Stanley Kaniel and tour of the facility was conducted.

During the visit LPA followed up on Administrator Certificate. According to the Licensee, the facility has shifted focus from hiring an Administrator due to all applicant’s failure to provide references. The Licensee further stated they have completed 25 of the 40 required hours to renew their Administrator Certificate. An Administrator was required to be in the facility by 2/19/2023 and 3/10/2023, but at this time the facility does not have an active Administrator.

The Licensee stated they signed a listing agreement on 4/3/2023, and pictures were taken 2 days ago (4/25/2023) to list the facility for sale. LPA discussed the closure plan with the licensee, which was due 4/10/2023. The licensee asked for an additional two weeks (5/11/2023) to complete the closure plan.

The following updates since LPA’s last visit was observed during the tour:

Building#1

· Bathroom#2 has new floor tiles.

· Bedroom #2 has a new dresser.


Report Continued on 809C
SUPERVISORS NAME: Lisa Hicks
LICENSING EVALUATOR NAME: Jewel Baptiste
LICENSING EVALUATOR SIGNATURE: DATE: 04/27/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/27/2023
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
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: 04/27/2023
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Building #2

· Bedroom# 4 heater was removed.

· Bedroom #5 room was painted, heater removed, and ceiling fans was installed.

· Bedroom #6 has a new door and heater removed.

Building #3

· Bedroom#12 has new lights, room painted, and mattresses removed.

· Bathroom#13 has new lights, replaced floor tiles and running water

· Bedroom#14 bed was removed

· During the visit staff was repairing living room floor tiles and Johnsons company was repairing fire alarm system.

· During the visit LPA observed some of the debris was removed from the back of the building.

· According to Administrator the roof is now repaired.


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: 04/27/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/27/2023
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 04/27/2023 02:53 PM - It Cannot Be Edited


Created By: Jewel Baptiste On 04/27/2023 at 02:31 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: 04/27/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
05/26/2023
Section Cited
CCR
85064(b)

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85064(b) Administrator Qualifications and Duties
(b) All adult residential facilities shall have a qualified and currently certified administrator.
This requirement is not met as evidenced by:
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The administrator will sign up for the classes required to complete the aditional 15 hours, renew Administrator certificate and send proof to LPA by POC due date.
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Based on observation, the Licensee did not comply with the section cited above because the Administrator certificate expired 3/12/2022. LPA also provided 2 seperate extensions (2/19/2023 and 3/10/2023) for the Licensee to hire an Administrator, which poses/posed a potential health, safety or personal rights risk to persons 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: 04/27/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/27/2023


LIC809 (FAS) - (06/04)
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