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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 191593145
Report Date: 05/25/2023
Date Signed: 05/25/2023 01:58:45 PM

Document Has Been Signed on 05/25/2023 01:58 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:
05/25/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Licensee Stanley Kaniel TIME COMPLETED:
02:15 PM
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On 5/25/2023 at 11:00 a.m., Licensing Program Analyst (LPA) Jewel Baptiste conducted an unannounced Case Management visit to ensure the Licensee is following Title 22 regulations, and to follow up on physical plant deficiencies observed. The purpose of the visit was explained to Licensee Stanley Kaniel, and a tour of the facility was conducted.

During the visit, LPA followed up on the Administrator Certificate. According to the Licensee, the renewal for the certificate was sent out to Sacramento 2 weeks ago. LPA tried to contact the Administration Certificate Section, but their office was closed. The automated line does not have further information about the certificate #6005797735 assigned to the licensee. LPA discussed the closure plan and the drafted letter that will be issued to the residents and their responsible party. According to the licensee, they will send the closure plan and drafted letter by 5/30/2023. Another topic discussed with the Licensee was the potential buyers for the facility. According to the licensee they have not accepted any offers at the moment, and they are still collecting offers till the end of next week. Once they received all the offers, they review them and choose a buyer.

Report continued on 809c

SUPERVISORS NAME: Lisa Hicks
LICENSING EVALUATOR NAME: Jewel Baptiste
LICENSING EVALUATOR SIGNATURE: DATE: 05/25/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/25/2023
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: 05/25/2023
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Kitchen, TV room, and Dining room
· No changes since last visit

Building#1
· Bedroom #2- A new bed was purchased and replaced for the resident.

Building#2


· No changes since the last visit.

Building #3
· Bedroom #9- Was painted
· Bedroom #11- Light fixture was put in but, need maintenance to secure it further.

Exit interview conducted with Licensee Stanley Kaniel and a copy of this report was provided.
SUPERVISORS NAME: Lisa Hicks
LICENSING EVALUATOR NAME: Jewel Baptiste
LICENSING EVALUATOR SIGNATURE:

DATE: 05/25/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/25/2023
LIC809 (FAS) - (06/04)
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