197608396-1-26-2026-28-AS-LDLN-DQQ344-20260126165432

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197608396
Report Date: 01/26/2026
Date Signed: 01/26/2026 04:54:52 PM

Document Has Been Signed on 01/26/2026 04:54 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
MONTEREY PARK ASC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754

FACILITY NAME:	GATEWAYS SATELLITE NORTH		FACILITY NUMBER:	197608396
ADMINISTRATOR/ DIRECTOR:	KEVIN MEJIA		FACILITY TYPE:	735
ADDRESS:	440 N HOOVER STREET		TELEPHONE:	(323) 644-2030
CITY:	LOS ANGELES	STATE: CA	ZIP CODE:	90004
CAPACITY: 18		CENSUS: 13	DATE:	01/26/2026
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	11:20 AM
MET WITH:	Residential Manager Amanda Walker		TIME VISIT/ INSPECTION COMPLETED:	05:15 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	License Program Analysts (LPA) Luis De Leon conducted an unannounced annual required visit. LPA met with Residential Manager Amanda Walker. The purpose of today’s visit was explained. The facility is licensed to serve 18 adults ages 18-59 of which 16 are ambulatory and 2 non-ambulatory clients. The LPA use the Compliance & Regulatory Enforcement Tool (CARE) during today’s inspection. The visit consisted as follows: FACILITY PHYSICAL PLANT The facility is a two-story building with parking garage in the basement. LPA toured the facility's physical plant indoor and outdoor, laundry room, four bathrooms, office, and 9 client bedrooms. All indoor and outdoor passages were free of obstruction. LPA observed two full bathrooms on each floor for clients use. All bathrooms were observed to be clean and had the required hygiene items. There are no large bodies of water on the premises such as pools. REVIEW OF FILES Client record review consisted of Admission Agreements, Identification and Emergency Info, Physicians Report, Consent Report, Needs and Service Plan, Personal Rights, and Centrally Store Medication. LPA was unable to review Physician’s report for Clients #2-#5 (C2-C5) and Needs and service plan for clients #2-#5 (C2-C5). A deficiency is noted on LIC-809D for clients records not available to review. Staff records were not available for LPA to review. Staff records are not stored at facility. A deficiency will be noted for records not available for licensing agency to inspect, audit, and copy upon demand during normal business hours. (Report continues on page LIC-809C...)

NAME OF LICENSING PROGRAM MANAGER: Fernando Fierros
NAME OF LICENSING PROGRAM ANALYST: Luis DeLeon
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 01/26/2026

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/26/2026

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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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
MONTEREY PARK ASC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754

FACILITY NAME: GATEWAYS SATELLITE NORTH	FACILITY NUMBER: 197608396
	VISIT DATE: 01/26/2026

NARRATIVE

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Observations during facility tour:

Client bedrooms had the required furniture including reasonable closet space for comfort and safety and in good condition. Client bedrooms also had sufficient lighting. Hygiene supplies are provided. Wall and floors are in good repair. Hallways were clean and free of obstructions.
Food is brought in for each meal and serve to clients. There is sufficient seven (7) day supply of non-perishable food. Dining room has sufficient seating area. Weekly food menu is posted at facility.
Toilets, showers, and water faucets are found operational. Restrooms were stocked and clean. The water temperature was tested and measured. The water temperature was found to be below Title 22 regulations requirement between 105º and 120º F degrees. First floor bathrooms: 92.3 and 96.5 degrees F. Second floor bathrooms: 93.4 and 95.8 degrees F
Sharps are locked inside the staff room and inaccessible to clients. Also, disinfectants and cleaning supplies are locked and secured inaccessible to clients.
There are four (4) Fire Extinguishers (two on each floor) in the hallways that are fully charged and last inspected on 09/04/2025.
Fire Alarm system was inspected on 10/13/2025 by private company and all fire devices including smoke detectors, and control system were tested and certified to be in working condition. Carbon monoxide detectors are tested and in working condition.
Last fire drill and disaster drill was conducted on 12/31/2025.
The medications are centrally stored and locked in the med-tech room. The facility uses the Medication Administration Record (MAR) log to document medications given. LPA reviewed medications for five (5) clients.
LPA conducted interviews with two staff. Client were not available to interview as clients were out in the community.

Per California Code of Regulations, Title 22, and California Health and Safety Code, the deficiencies observed during the visit are documented on the LIC-809D page. Exit interview was held and copies of reports LIC-809, LIC-809C, LIC 809D, and Appeal Rights were discussed and provided to Administrator Myra Garcia.

NAME OF LICENSING PROGRAM MANAGER: Fernando Fierros
NAME OF LICENSING PROGRAM ANALYST: Luis DeLeon
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 01/26/2026

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/26/2026

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 01/26/2026 04:54 PM - It Cannot Be Edited

Created By: Luis DeLeon On 01/26/2026 at 04:09 PM

Link to Parent Document Below:

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754

FACILITY NAME: GATEWAYS SATELLITE NORTH	FACILITY NUMBER: 197608396
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 01/26/2026

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

85068.2(b)(1)(F)

Needs and Services Plan

(b) If the client is to be admitted, then prior to admission, the licensee shall complete a written Needs and Services Plan, which shall include: (1) The client's desires and background, obtained from the client, the client's family or his/her authorized representative, if any, and licensed professional, where appropriate, regarding the following: (F) The written functional capabilities assessment specified in Section 80069.2. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on interview and record review, the licensee did not comply with the section cited above in three (3) out of five (5) client records for clients C2, C4, and C5 where there was no needs and service plan for clients in care which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 02/09/2026
	Plan of Correction
1 2 3 4	Licensee shall create a needs and service plan for clients C2, C4, and C5 and submitt a copy to CCLD by POC Date.

Type B

Section Cited

CCR

80069(c)(1)

Client Medical Assessments

(c) The medical assessment shall include the following: (1) The results of an examination for communicable tuberculosis and other contagious/infectious diseases. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on interview and record review, the licensee did not comply with the section cited above in four (4) out of five (5) client where tuberculosis results for clients C2-C5 were not available to review which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 02/09/2026
	Plan of Correction
1 2 3 4	Licensee shall provide a TB test results for clients C2-C5 and submitt a copy to CCLD by POC Date.

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

	Fernando Fierros
NAME OF LICENSING PROGRAM MANAGER:

	Luis DeLeon
NAME OF LICENSING PROGRAM ANALYST:

LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 01/26/2026

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/26/2026

LIC809 (FAS) - (06/04)

Page: 4 of 6

Document Has Been Signed on 01/26/2026 04:54 PM - It Cannot Be Edited

Created By: Luis DeLeon On 01/26/2026 at 04:26 PM

Link to Parent Document Below:

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754

FACILITY NAME: GATEWAYS SATELLITE NORTH	FACILITY NUMBER: 197608396
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 01/26/2026

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

80088(e)(1)

(e) Faucets used by clients for personal care such as shaving and grooming shall deliver hot water. (1) Hot water temperature controls shall be maintained to automatically regulate temperature of hot water delivered to plumbing fixtures used by clients to attain a hot water temperature of not less than 105 degrees F (40.5 degrees C) and not more than 120 degrees F (48.8 degrees C). This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation and interview, the licensee did not comply with the section cited above in in four client bathrooms where water temperature was measured for first floor bathrooms: 92.3 and 96.5 degrees F. Second floor bathrooms: 93.4 and 95.8 degrees F which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 02/09/2026
	Plan of Correction
1 2 3 4	Licensee shall provide proof of water heater repair by POC date and provide a daily water temperture log to CCLD to ensure that water temperature reading is between 105-120 degrees F as per title 22 regulations.

Type B

Section Cited

CCR

80069(b)

In ARFs , prior to accepting a client into care, the licensee shall obtain and keep on file documentation of the client's medical assessment. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on interview and record review, the licensee did not comply with the section cited above in four (4) out of five(5) client medical assessmente for clients C2-C5 were not availble for review which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 02/02/2026
	Plan of Correction
1 2 3 4	Licensee shall create medical assessments for clients C2-C5 and submitt medcial assessment to CCLD by POC date.

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

	Fernando Fierros
NAME OF LICENSING PROGRAM MANAGER:

	Luis DeLeon
NAME OF LICENSING PROGRAM ANALYST:

LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 01/26/2026

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/26/2026

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 01/26/2026 04:54 PM - It Cannot Be Edited

Created By: Luis DeLeon On 01/26/2026 at 04:32 PM

Link to Parent Document Below:

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754

FACILITY NAME: GATEWAYS SATELLITE NORTH	FACILITY NUMBER: 197608396
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 01/26/2026

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

80066(c)

80066 (c) All personnel records shall be available to the licensing agency to inspect, audit, and copy upon demand during normal business hours. Records may be removed if necessary for copying… This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on interview, the licensee did not comply with the section cited above in all staff records requested were not available at facility for LPA to review which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 02/09/2026
	Plan of Correction
1 2 3 4	LIcensee shall make requested staff records available to CCLD for staff S1-S6 by POC date.

Section Cited


	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

	Fernando Fierros
NAME OF LICENSING PROGRAM MANAGER:

	Luis DeLeon
NAME OF LICENSING PROGRAM ANALYST:

LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 01/26/2026

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/26/2026

LIC809 (FAS) - (06/04)

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