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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 191593145
Report Date: 06/16/2023
Date Signed: 06/16/2023 01:34:19 PM

Document Has Been Signed on 06/16/2023 01:34 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:
06/16/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Licensee Stanley KanielTIME COMPLETED:
01:45 PM
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On 6/16/2023 at 9:30 a.m., Licensing Program Analysts (LPAs) Jewel Baptiste and Bennette Pena 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.

Prior to today’s visit LPA verified Licensee Stanley Kaniel Administrator certificate is currently pending in Sacramento. LPA also received the closure plan from Licensee Stanley Kaniel and was missing physicians report.

During the visit, LPAs discussed the closure plan and the missing documentation, to which Licensee Stanley confirmed a due date of 6/23/2023 . According to the Licensee, a meeting will be Held Monday 6/19/2023 or Tuesday 6/20/2023 to review the buy offers. LPAs also discussed the facility fire inspection with Licensee. According to licensee the Fire Marshall inspected the fire panel on 6/7/2023 or 6/8/2023. Currently the facility is still on fire watch. LPAs toured the facility and observed the following:

Report Continued on 809c

SUPERVISORS NAME: Lisa Hicks
LICENSING EVALUATOR NAME: Jewel Baptiste
LICENSING EVALUATOR SIGNATURE: DATE: 06/16/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/16/2023
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 5
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: 06/16/2023
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During today’s visit, LPAs observed the following:
Building #1
· Room #1
1. Residents has new beds.
2. Blinds were in disrepair.
3. Resident has a new dresser.
4. Ceiling fan was replaced.

· Bathroom for room #1
1. Floor tiles replaced.
2. Bathroom cabinet was replaced.
3. Bathroom walls was painted.

· Room#2
1. Residents has new beds.
2. Large Dresser will be moved (blocking window).

· Bathroom
1. Floor tiles was replaced.
2. Bathroom tub was reglazed.
3. Medicine cabinet mirror was broken and in disrepair.

· Bedroom#3
1.Night stands have signs of wear and tear and will need replacing.
2.Possible mold like substance on the wall and need to be cleaned.
SUPERVISORS NAME: Lisa Hicks
LICENSING EVALUATOR NAME: Jewel Baptiste
LICENSING EVALUATOR SIGNATURE:

DATE: 06/16/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/16/2023
LIC809 (FAS) - (06/04)
Page: 2 of 5
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: 06/16/2023
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Building #2
· Bedroom #5
1.Heater was removed.
2.Outlet need to be repaired.

· Bedroom #6
1. Toilet was cleaned.
2. Sink, and shower was covered in stains and needs cleaning.
3. Heater was removed.

Building #3
· Bedroom#7
1. Need additional lighting.
2. Floor tiles in disrepair and need to be replaced.
3. Need additional curtain.

· Bedroom#8
1.Closet door in disrepair.

· Bathroom for rooms #7 and #8
1. Need window covering.
2. Need additional lighting.

Report continued on 809c

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

DATE: 06/16/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/16/2023
LIC809 (FAS) - (06/04)
Page: 3 of 5
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: 06/16/2023
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·Bedroom #9
1.Floor tiles are in disrepair and needs to be replaced.
2.Room was painted.
3.Need a plate/cover over outlet.

· Bedroom #10
1.Closet door in disrepair.

· Bathroom for room #9 and #10
1.Floor tiles in disrepair and need to be replaced.
2.Bathroom window in disrepair.

· Bedroom#11
1. Floor tiles in disrepair and need to be replaced.
2. Need additional lighting.
3. Need a new dresser.

· Bedroom #12
1.Need additional curtains.
2.Need additional lighting.
3.Floor tiles in disrepair and need to be replaced.

Report continued on 809c
SUPERVISORS NAME: Lisa Hicks
LICENSING EVALUATOR NAME: Jewel Baptiste
LICENSING EVALUATOR SIGNATURE:

DATE: 06/16/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/16/2023
LIC809 (FAS) - (06/04)
Page: 4 of 5
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: 06/16/2023
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··Bedroom#13
1. Floor tiles were in disrepair and need to be replaced.
2. Need additional curtain.

Bathroom for bedroom #13
1. Floor tiles were in replaced.
2. Bathroom lights was repaired.
3. Large Dresser will be moved (blocking window).

· Bedroom #14
1. Floor tiles were in disrepair and need to be replaced.
2. Hospital bed was removed.
3. Need additional curtain.

· Bedroom #15
1.Floor tiles in disrepair and need to be replaced.

· T.V Room
1. Couches were in disrepair and need replacing.
2. Window is missing screens.

· Dining room
1.Floor tiles were in disrepair and need to be replaced.
2.Light needs cover.

Licensee will continue to repair the facility and agreed on a due date of 7/17/2023. Exit interview conducted with Care Staff Gloria Zadala and a copy of this report was provided.
SUPERVISORS NAME: Lisa Hicks
LICENSING EVALUATOR NAME: Jewel Baptiste
LICENSING EVALUATOR SIGNATURE:

DATE: 06/16/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/16/2023
LIC809 (FAS) - (06/04)
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