197801279-8-11-2026-28-AS-CDCN-DWURW8-20260811132244

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197801279
Report Date: 08/11/2026
Date Signed: 08/11/2026 01:22:58 PM

Document Has Been Signed on 08/11/2026 01:22 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:	LEANING PINE, THE		FACILITY NUMBER:	197801279
ADMINISTRATOR/ DIRECTOR:	VILLAFLOR, ELNA C.		FACILITY TYPE:	740
ADDRESS:	1809 LEANING PINE DRIVE		TELEPHONE:	(909) 396-4675
CITY:	DIAMOND BAR	STATE: CA	ZIP CODE:	91765
CAPACITY: 6		CENSUS: 5	DATE:	08/11/2026
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	10:15 AM
MET WITH:	Raquel Salen, staff		TIME VISIT/ INSPECTION COMPLETED:	01:30 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	Licensing Program Analyst (LPA) Cynthia Chan conducted the annual inspection using the Compliance and Regulatory Enforcement (CARE) tools. LPA arrived unannounced and met with staff Raquel Salen. The purpose of the visit was explained. The facility is approved to serve (6) non-ambulatory residents, ages 60 and over, and (1) may be bedridden. The bedridden fire clearance is approved for bedroom #1 only. There is a hospice waiver approved for (6) residents. LPA toured the facility, reviewed documents and medications, and conducted interviews. The facility is a single story home with (4) resident bedrooms, (1) staff room, 2 bathrooms, living room with dining area, a den, kitchen, laundry area, and attached garage. The facility has an operable carbon monoxide detector and smoke detectors throughout the home. The outdoor has a shaded area with table and chairs. The fireplace is adequately screened. Knives and cleaning solutions are stored in the kitchen and inaccessible to residents. Sufficient food supplies of 2-day perishable and a week of non-perishable items are observed. Facility has sufficient space to accommodate indoor and outdoor activities. The hot water temperature in the bathroom and kitchen was measured over 120 degrees F today. LPA reviewed (5) resident files. Medications are centrally stored and locked. Facility uses the Medication Administration Record (MAR) log to document medications given and they being given as prescribed. LPA provided a technical violation for resident reappraisals to be updated at least once every 12 months. LPA reviewed (3) Staff files. The administrator's (Elna Villaflor) certificate expires on 6/5/28. Staff have current CPR & First Aid certificates and receiving annual training. The Emergency Disaster Plan is being reviewed annually and disaster drills are being conducted at least quarterly. A deficiency was issued today. An exit interview was held. A copy of this report and appeal rights were given to Staff Z. Uy.

Fernando Fierros
Cynthia D Chan
	DATE: 08/11/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/11/2026

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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Document Has Been Signed on 08/11/2026 01:22 PM - It Cannot Be Edited

Created By: Cynthia D Chan On 08/11/2026 at 01:07 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: LEANING PINE, THE	FACILITY NUMBER: 197801279
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 08/11/2026

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type A

Section Cited

CCR

87303(e)(2)

Maintenance and Operation

(2) Faucets used by residents for personal care such as shaving and grooming shall deliver hot water. Hot water temperature controls shall be maintained to automatically regulate the temperature of hot water used by residents to attain a temperature of not less than 105 degree F (41 degrees C) and not more than 120 degree F (49 degrees C). This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation, the licensee did not comply with the section cited above in that the hot water temperature was measure at 127 degrees F in the bathroom and kitchen which poses an immediate health, safety or personal rights risk to persons in care.
	POC Due Date: 08/12/2026
	Plan of Correction
1 2 3 4	Licensee shall submit a plan to ensure the hot water temperature stays within the range of 105-120 degrees F. The plan is due to LPA by 8/12/26.

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:

	Cynthia D Chan
NAME OF LICENSING PROGRAM ANALYST:

LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 08/11/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/11/2026

LIC809 (FAS) - (06/04)

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