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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197801985
Report Date: 04/09/2026
Date Signed: 04/09/2026 05:45:36 PM

Document Has Been Signed on 04/09/2026 05:45 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:LOVE N CARE GUEST HOMEFACILITY NUMBER:
197801985
ADMINISTRATOR/
DIRECTOR:		BRILLANTES, HARRYFACILITY TYPE:
735
ADDRESS:11866 E. 162ND. ST.TELEPHONE:
(562) 404-7601
CITY:NORWALKSTATE: CAZIP CODE:
90650
CAPACITY: 8CENSUS: 8DATE:
04/09/2026
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:24 AM
MET WITH:Staff-IreneTIME VISIT/
INSPECTION COMPLETED:
05:55 PM
NARRATIVE
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Licensing Program Analyst (LPA) Elena Mallett conducted an unannounced Annual Inspection of the facility. LPA met with Staff in Charge Irene and the purpose of the visit was explained. House Manager, Luz Brillantes was contacted by phone and made aware of the visit.

The facility is located in a residential neighborhood in Norwalk. The facility consists of a living room/dining room, kitchen, 4 shared client bedrooms, staff bedroom and staff bathroom and two client bathrooms. There is an attached garage and a backyard area and front yard area that are shaded and furnished.

LPA completed the visit using Compliance and Regulatory Enforcement Tools (CARE) . The following domains were completed during the visit

Infection Control: Infection Control Plan was reviewed by LPA. Plan follows title 22 regulations. Staff is cleaning and wiping down high touch areas daily.

Physical Plant and Environmental Safety: Physical plant was clean with hallways and walkways free from debris and obstruction. The hot water temperature in the 2 client restrooms measured within Title 22 regulations of 105F-120F . Grab bars and slip mats for the shower were observed in the restrooms .The shower door in bathroom #1 was observed to be inoperable and the area in and around shower needed cleaning. A deficiency was cited. See 809-D Smoke and CO2 detectors were present and operational.Knives Sharps and toxins and cleaners are locked in the garage and inaccessible to clients however there were cleaning products present under the kitchen sink in an unlocked cabinet that was accessible to clients. A deficiency was cited. See 809-D Required furnishings and light were present in all client bedrooms. Extra linens and hygiene supplies were observed. The kitchen had operational appliances and was equipped to prepare and store food.The oven did not work and had a missing knob. A deficiency was cited. See 809-D The backyard patio and front yard was free of debris and obstruction and contained a shaded area with furniture for the clients to enjoy the outdoors. A 2 day supply of perishable food and 7 day supply of

NAME OF LICENSING PROGRAM MANAGER: Fernando Fierros
NAME OF LICENSING PROGRAM ANALYST: Elena Mallett
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 04/09/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/09/2026
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 04/09/2026 05:45 PM - It Cannot Be Edited


Created By: Elena Mallett On 04/09/2026 at 04:39 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: LOVE N CARE GUEST HOME
FACILITY NUMBER: 197801985

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/09/2026

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
80087(g)
Building and Grounds
(g) Disinfectants, cleaning solutions, poisons, firearms and other items that could pose a danger if readily available to clients shall be stored where inaccessible to clients.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, the licensee did not comply with the section cited above in that there was several cleaning solutions under the kitchen sink in an unlocked cabinet and were accessible to clients which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 04/10/2026
Plan of Correction
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BY POC due date Administrator will fax to LPA a statement of understanding of the above regulation signed by all staff members. Cleaning solutions were relocated to the locked garage during visit.
Type A
Section Cited
CCR
80075(b)
Health-Related Services
(b) Clients shall be assisted as needed with self-administration of prescription and nonprescription medications.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on interview and record review, the licensee did not comply with the section cited above in 1 out of 8 clients( Client 4) was not given Documsate Sodium 100 mg for the last four days as prescribed and MAR log for Docusate Sodium 250mg was marked given every day and it should have been marked three times a week which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 04/10/2026
Plan of Correction
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By POC due date Administrator will fax to LPA a statement of understanding of the above regulation signed by staff administering medications to clients. Administrator will arrange for a pharmacist-led medication training for staff administering medication and fax LPA proof of this training within five days.
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:
Elena Mallett
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 04/09/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/09/2026


LIC809 (FAS) - (06/04)
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Document Has Been Signed on 04/09/2026 05:45 PM - It Cannot Be Edited


Created By: Elena Mallett On 04/09/2026 at 04:39 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: LOVE N CARE GUEST HOME
FACILITY NUMBER: 197801985

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/09/2026

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
80087(a)
Building and Grounds
(a) The facility shall be clean, safe, sanitary and in good repair at all times for the safety and well-being of clients, employees and visitors.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, the licensee did not comply with the section cited above in that one of the drawers was missing on chest of drawers in bedroom 2, the shower door in bathroom 1 is inoperable, will not slide shut and area in and around shower in bathroom 1 needs a thourough cleaning and oven has broken knob and is not operational which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 04/23/2026
Plan of Correction
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By POC due date Administrator will email photos of items to be repaired and cleaned to LPA demonstrating proof of correction.
Type B
Section Cited
CCR
80065(a)
Personnel Requirements
(a) Facility personnel shall be competent to provide the services necessary to meet individual client needs and shall, at all times, be employed in numbers necessary to meet such needs.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on (record review)], the licensee did not comply with the section cited above in Staff 2, 3 and 4 did not contain proof of any ongoing trainings in their file which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 04/23/2026
Plan of Correction
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By POC due date Administrator will provide proof of 12 hours of inservice training for Staff 2,3 and 4 on topics relevant to serving Adult Residential Facility clients.
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:
Elena Mallett
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 04/09/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/09/2026


LIC809 (FAS) - (06/04)
Page: 4 of 6
Document Has Been Signed on 04/09/2026 05:45 PM - It Cannot Be Edited


Created By: Elena Mallett On 04/09/2026 at 04:39 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: LOVE N CARE GUEST HOME
FACILITY NUMBER: 197801985

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/09/2026

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
HSC
1565(c)
Other Provisions
(c) A facility shall conduct a drill at least quarterly for each shift. The type of emergency covered in a drill shall vary from quarter to quarter, taking into account different emergency scenarios. An actual evacuation of individuals served by the facility is not required during a drill. While a facility may provide an opportunity for individuals served by the facility to participate in a drill, it shall not require that participation. Documentation of the drills shall include the date, the type of emergency covered by the drill, and, if applicable, the names of staff participating in the drill.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on [(observation) and (record review)], the licensee did not comply with the section cited above in that no disaster drills have been conducted in over a year which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 04/16/2026
Plan of Correction
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By POC due date Administrator will fax to LPA proof that a disaster drill has been conducted with all shifts.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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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:
Elena Mallett
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 04/09/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/09/2026


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
MONTEREY PARK ASC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754
FACILITY NAME: LOVE N CARE GUEST HOME
FACILITY NUMBER: 197801985
VISIT DATE: 04/09/2026
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prepare and store food. The oven did not work and had a missing knob. A deficiency was cited. See 809-D The backyard patio and front yard was free of debris and obstruction and contained a shaded area with furniture for the clients to enjoy the outdoors. A 2 day supply of perishable food and 7 day supply of non- perishable food was observed. A fully charged fire extinguisher was present in the kitchen. The garage is locked and used to store medications, staff and client files and laundry facilities. Clients do their own laundry but are under constant supervision while in garage.

Operational Requirements: Fire clearance approval was observed. Plan of operation was observed. Outdoor activity space and supplies for clients was observed. Facility handles P&I money for one client . The ledger were observed with no issues.

Personal Records - Training: Locked storage space for staff files was observed. 3 staff files were reviewed Administrator Harry Brillantes file was at another location. Documents will be faxed to LPA. Staff files were reviewed and issues were noted. A deficiency was cited. See 809-D

Client Records - Incident Reports: Locked Storage space for client files and medications was observed.5 client files and 8 client medication files were reviewed. An issue was noted with a client medication file. A deficiency was cited. See 809-D.

Client Rights - Information: All required postings were present.

Food Service: 2 day perishable and 7 day non perishable supply was observed. Food kept separate from toxins and posions and cleaners.

Health Related Services: First Aid Kit was observed..

Disaster Preparedness: Facility has emergency food, water and several flashlights. Administrator had a disaster plan and emergency numbers posted but were from several years ago. Staff Irene stated a current, new disaster plan will be faxed to LPA. Disaster drills have not been run in the last year. A deficiency was cited. See 809-D

Per Title 22 regulations there were deficiencies cited today. An exit interview was conducted with Staff-in-charge Irene and copy of this Licensing Report along with Appeal Rights was provided.

NAME OF LICENSING PROGRAM MANAGER: Fernando Fierros
NAME OF LICENSING PROGRAM ANALYST: Elena Mallett
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 04/09/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/09/2026
LIC809 (FAS) - (06/04)
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