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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 191593145
Report Date: 03/10/2023
Date Signed: 03/10/2023 11:58:42 AM

Document Has Been Signed on 03/10/2023 11:58 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: 22DATE:
03/10/2023
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
10:43 AM
MET WITH:Licensee Stanley KanielTIME COMPLETED:
12:10 PM
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On 3/10/2023 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 today's visit, LPA observed the hot water temperature measured at 125.3 in room #7, 135.5 in room #14, and in room #13 the hot water faucet is not operational During the visit the Licensee gave a hot water-log to LPA that shows hot water is within compliance. LPA has granted an extension for the water temperature due on 3/13/2023.

Building #1

Bathroom#1

· Has a new toilet.

· Floors tiles is replaced.


Report Continued on 809C
SUPERVISORS NAME: Lisa Hicks
LICENSING EVALUATOR NAME: Jewel Baptiste
LICENSING EVALUATOR SIGNATURE: DATE: 03/10/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/10/2023
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 2
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: 03/10/2023
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Building #2

Bedroom #4

· The bedroom is repainted.

· The heater is removed.

Bedroom #5

· The bedroom is repainted.

· The heater is removed.

· The Licensee stated floors will be done in a week.

Licensee also stated the facility has completed medication training and will send certificates to LPA.

Exit Interview Conducted with Licensee Stanley Kaniel / A Copy of the Report Issued.

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

DATE: 03/10/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/10/2023
LIC809 (FAS) - (06/04)
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