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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197607882
Report Date: 07/30/2026
Date Signed: 07/30/2026 02:02:56 PM

Document Has Been Signed on 07/30/2026 02:02 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:ANGEL ASSISTED LIVING SERVICESFACILITY NUMBER:
197607882
ADMINISTRATOR/
DIRECTOR:		ELVIRA CLAVERIAFACILITY TYPE:
740
ADDRESS:4401 234TH PLACETELEPHONE:
(310) 373-9275
CITY:TORRANCESTATE: CAZIP CODE:
90505
CAPACITY: 6CENSUS: 6DATE:
07/30/2026
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:55 AM
MET WITH:LEAD CARE GIVER - Elvira BrondialTIME VISIT/
INSPECTION COMPLETED:
02:00 PM
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On 07/30/2026, Licensing Program Analyst (LPA), Troy Watson conducted an unannounced annual visit using the CARE Inspection Tool. The Department met with lead caregiver Elvira Brondial, and the purpose of today’s visit was explained. The Department was granted entry into the facility. We were later joined by Licensee, Leia Joaquin. The facility is licensed to serve six (6) bedridden elderly adults aged 60 and above, with an approved hospice waiver for one (1) resident.

Physical Plant/Structure The facility is a single-story structure located in a residential neighborhood. It consists of six (6) resident bedrooms, one (1) staff bedroom, three (3) bathrooms, living room, dining room, kitchen, attached garage, and an outside area. During the inspection, The Department observed all walkways around the outside of the facility were observed clean, clear, and free of debris, obstructions, and hazards. The Department observed a table with an umbrella and chairs for residents’ use. The Department did not observe any bodies of water on the premises.

CONTINUED ON LIC9099-C

Stephanie Cifuentes
Troy Watson
DATE: 07/30/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/30/2026
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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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: ANGEL ASSISTED LIVING SERVICES
FACILITY NUMBER: 197607882
VISIT DATE: 07/30/2026
NARRATIVE
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Bedrooms: The Department inspected all residents’ bedrooms. The Department observed all bedrooms were clean and in good repair. The Department observed all rooms have the required furniture including a bed, dress, nightstand, chair, and ample storage space for resident’s personal belongings. The Department observed the beds have the required linens including a mattress cover, fitted sheets, blanket, comforter, and pillows. The Department observed an additional supply of linens, in good repair, stored in a closet in the hallway. All bedrooms were observed with ample lighting.

Bathrooms: The Department inspected all bathrooms and fount them to meet Title 22 regulations and were operable. The Department observed the showers are clean and free mold and mildew. The Department observed resident hygiene boxes stored in a closet in the hallway. The Department observed an additional supply of hygiene products stored in the closet in the hallway. The Department observed an ample supply of towels, hand towels, wash cloths and linen in the facility. The Department observed safety handrails secured and properly placed in the facility. The Department observed an ample supply of incontinent products and supplies. The Department observed cleaning supplies secured in locked cabinets under the sinks. The water temperature measured in bathroom #1 (113.4 F) in bathroom #2 (115.5 F) in bathroom #3 (110.7 F).

Kitchen: The Department inspected the kitchen and observed it to be clean and sanitary. The Department observed all appliances are operable and in good repair. The Department observed an ample supply of dishware, cookware, and cutlery in good repair.

CONTINUED ON LIC9099-C

NAME OF LICENSING PROGRAM MANAGER: Stephanie Cifuentes
NAME OF LICENSING PROGRAM ANALYST: Troy Watson
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 07/30/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/30/2026
LIC809 (FAS) - (06/04)
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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: ANGEL ASSISTED LIVING SERVICES
FACILITY NUMBER: 197607882
VISIT DATE: 07/30/2026
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The Department observed a 3- day supply of perishable foods, and a 7- day supply of nonperishable foods properly stored, labeled, and dated. The Department observed cleaning supplies and toxins secured in the locked cabinet under the kitchen sink and are inaccessible to residents. The water temperature measured 110.5 F.

Common Areas: The Department observed in the living room there are four (4) recliners and two (2) chairs available for residents’ use. The Department observed games and activities available for residents. The dining room has a large table with chairs to accommodate all residents. The Department observed the facility was appropriately furnished during the visit. The Department did observe a screened fireplace inaccessible to residents. All walkways and hallways inside the facility were observed clean, clear, and free of obstructions and hazards. The facility was maintained at a comfortable temperature of 74-degrees Fahrenheit.

Files The Department reviewed the file for four (4) residents and found they contained the required documents. The Department reviewed the Administrator and three (3) staff files and found they contained the required documents, training, and certifications. The Administrator Certificate is valid till 07/19/2027.

Medications The Department observed medications secured in a locked cabinet in the kitchen and are inaccessible to residents. The Department observed medications in their original packaging. The Department reviewed the medication and Medication Administration Record (MAR) and found them consistent with properly documented records.

CONTINUED ON LIC9099-C

NAME OF LICENSING PROGRAM MANAGER: Stephanie Cifuentes
NAME OF LICENSING PROGRAM ANALYST: Troy Watson
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 07/30/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/30/2026
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: ANGEL ASSISTED LIVING SERVICES
FACILITY NUMBER: 197607882
VISIT DATE: 07/30/2026
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Safety The Department observed smoke and carbon monoxide detectors are operable. The Department observed two (2) fully charged fire extinguishers lasted serviced on. The last fire prevention was conducted by the Torrance Fire Department on 07/23/2026. The last emergency drill was conducted 07/06/2026. The Department reviewed the facility’s liability insurance through Acord that is valid till 12/09/202.

The Department reviewed the Emergency and Disaster Plan for Residential Care Facilities for the Elderly (LIC610E) that was last updated on 04/01/2026. The Department inspected the First Aid kit and observed it containing the required items and a current manual. The facility has an operational landline telephone. All exits are marked with an EXIT sign. All doors have an alarm that chimes when a person tries to exit and the facility door is opened. The Department observed all required postings posted in the hallway at the entrance of the facility.

Infection Control During the visit, The Department observed the facility’s infection control practices. The Department observed a sanitizing station at the entrance of the facility that has a visitor log, hand sanitizer, thermometer, and masks. The Department observed the facility has a 30 - day supply of Personal Protective Equipment (PPE). The Department observed all required infection control signs were posted in the facility.

During today’s visit, The Department did not observe or cite any deficiencies.

An exit interview was conducted with Licensee, Leia Joaquin, and a copy of this report was provided.

NAME OF LICENSING PROGRAM MANAGER: Stephanie Cifuentes
NAME OF LICENSING PROGRAM ANALYST: Troy Watson
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 07/30/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/30/2026
LIC809 (FAS) - (06/04)
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