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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 191603749
Report Date: 12/29/2025
Date Signed: 12/29/2025 12:49:38 PM

Document Has Been Signed on 12/29/2025 12:49 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
EL SEGUNDO ASC, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245
FACILITY NAME:MANOR, THEFACILITY NUMBER:
191603749
ADMINISTRATOR/
DIRECTOR:		STEPHANIE BROWNFACILITY TYPE:
735
ADDRESS:1905/2019 PICO BOULEVARDTELEPHONE:
(310) 450-1748
CITY:SANTA MONICASTATE: CAZIP CODE:
90405
CAPACITY: 151CENSUS: 107DATE:
12/29/2025
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:15 AM
MET WITH:Stephanie Brown-AdministratorTIME VISIT/
INSPECTION COMPLETED:
01:00 PM
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On 12/29/2025, Licensing Program Analyst (LPA) Bernadette Allen conducted an unannounced visit to conduct an annual required inspection. LPA met with Stephanie Brown Administrator who was informed of the purpose of the visit.

The facility is licensed to serve (151) mentally disabled ambulatory clients only.

The facility is located in a residential area, it consists of two buildings. The first building is at 1905 Pico Blvd., referred to as the "main" building. It consists of a tri-level complex with twenty-three residential suites which may contain one up to four resident bedrooms and a pool.



The second building is located at 2019 Pico Blvd. Santa Monica CA consists of two-story complex with fourteen resident suites- two additional suites #9 and #15 designated as office and staff quarters.

At 9:30 AM, LPA reviewed seven (7) staff files for First Aid/CPR certification, criminal record clearance, training's, and health screenings, which appeared to be current. LPA recommended health screening to be be conducted every 2 years. LPA also reviewed seven (7) clients files for admission agreements, updated physician reports, needs and services plans which appeared to be up to be current.

LPA also conducted an audit of clients Medication Administration Record (MARS) which appeared that clients medications are being administered as prescribed by their physician.
Continued
NAME OF LICENSING PROGRAM MANAGER: Stephanie Cifuentes
NAME OF LICENSING PROGRAM ANALYST: Bernadette Allen
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 12/29/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/29/2025
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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California Health & Human Services Agency
California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:
  • Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.
  • Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)
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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245
FACILITY NAME: MANOR, THE
FACILITY NUMBER: 191603749
VISIT DATE: 12/29/2025
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At 11:20 PM ,LPA Allen and Stephanie toured the physical plant at both locations. There was a body of water on the premise and no obstructions on the premises.

LPA inspected a total of (15) bedrooms and (15) bathrooms. The beds and bedding supplies were in good condition, adequate lighting was provided, and storage for the clients’ personal belongings.

The bathrooms appeared to be clean and operational. The water temperature ranged from 105.°F to 120 °F, the bathtub in room #5 and #1 needs to be refinished/glazed. Stephanie informed LPA that renovations are being conducted throughout the facility in the bathrooms. LPA also observed invoices that reflect renovations of bathrooms/tubs.

LPA observed that facilities kitchen to have a 5-day supply of perishables and a 7-day supply of non-perishables food items for the number of clients in care which were stored and maintained properly.

There was also a menus available for review.

LPA Allen observed the storage area where the cleaning supplies, toxins, and sharps objects were inaccessible to clients.

Smoke detectors were observed to be fully changed, tested and operating. The fire extinguishers were fully charged, and the last fire drill was conducted on 6/5/2025..


During the inspection LPA Allen did not observe deficiencies therefore no citations were issued. LPA also emailed Stephanie the Annual/Inspection requirements and the LIC9241 for reference.

An exit interview was conducted, where this report was discussed and provided to Stephanie Brown- Administrator at the conclusion of the visit.
NAME OF LICENSING PROGRAM MANAGER: Stephanie Cifuentes
NAME OF LICENSING PROGRAM ANALYST: Bernadette Allen
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 12/29/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/29/2025
LIC809 (FAS) - (06/04)
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