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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197802315
Report Date: 09/08/2025
Date Signed: 09/08/2025 01:17:19 PM

Document Has Been Signed on 09/08/2025 01:17 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
GREATER LA AC/SC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754
FACILITY NAME:VRAM ADULT FAMILY HOMEFACILITY NUMBER:
197802315
ADMINISTRATOR/
DIRECTOR:		LAURETTA, AURAFACILITY TYPE:
735
ADDRESS:2327 HILLVIEW AVE.TELEPHONE:
(323) 721-9618
CITY:MONTEREY PARKSTATE: CAZIP CODE:
91754
CAPACITY: 4CENSUS: 5DATE:
09/08/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:39 AM
MET WITH:Rachel Marquez De Sanchez, DSP, Aura Luaretta, Licensee, Alexis Valdez, Lead staff. TIME VISIT/
INSPECTION COMPLETED:
01:21 PM
NARRATIVE
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Licensing Program Analyst (LPA) Alberto Lopez conducted an unannounced Required- 1 year visit using the full Care Compliance and Regulatory Enforcement (CARE) Tools. LPA met with Rachel Gomez, DSP, and Aura Lauretta, Manager and explained the reason of the visit. Alexis Valdez, Lead Staff arrived a short time later and assisted with the visit. The facility is approved for serve Developmentally Disabled Adults, four (4) ambulatory clients. The facility is licensed as a level 2 home vendored by East Los Angeles Regional Center.

1. Infection Control: Infection control practices and Personal Protective Equipment (PPEs) were observed. The facility still encourages hand washing, still checking client temperature twice a day and staff disinfected the facility every shift. The facility has an Infection Control Plan and COVID-19 mitigation plan in place.

2. Physical Environmental and Safety: The facility is a single-story house and located in a residential neighborhood area. The facility includes living room #1, kitchen, dining area, den/staff office/client's activity room, two client shared bedrooms and 1 client bathroom, laundry room and a detached garage. required furniture and bedding and sufficient lighting and closet space. The client bathroom is clean, sanitary and in good working condition. The hot water was tested between 117.9 – 129.0 degrees F which are not within the Title 22 regulation of 105 – 120 degrees F. The appliances in the living room and kitchen are working well. The knives and sharp utensils are stored and locked in the cabinet behind the washer and dryer.

All the chemicals and cleaning supplies are stored and were not locked in the kitchen and not accessible to clients. The extra linen and personal hygiene products are stored in the hallway cabinet/closet. The facility does not have a working landline telephone system for clients to use. The hallway light is always on during night timed for clients to access the non-private bathrooms. LPA inspected the carbon monoxide detectors and smoke detectors, and they are all working well. The passageway, walkway and patio are free of obstruction. (Continued on 809C)

NAME OF LICENSING PROGRAM MANAGER: Lisa Hicks
NAME OF LICENSING PROGRAM ANALYST: Alberto Lopez
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 09/08/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/08/2025
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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Document Has Been Signed on 09/08/2025 01:17 PM - It Cannot Be Edited


Created By: Alberto Lopez On 09/08/2025 at 12:47 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: VRAM ADULT FAMILY HOME
FACILITY NUMBER: 197802315

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/08/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
80088(e)(1)
Fixtures, Furniture, Equipment, and Supplies
(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
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Based on observation, the licensee did not comply with the section cited above. The water temperature measured between 117.9 – 129.0 degrees F which are not within the Title 22 regulation of 105 – 120 degrees F. which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 09/09/2025
Plan of Correction
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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.
Lisa Hicks
NAME OF LICENSING PROGRAM MANAGER:
Alberto Lopez
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 09/08/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/08/2025


LIC809 (FAS) - (06/04)
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Document Has Been Signed on 09/08/2025 01:17 PM - It Cannot Be Edited


Created By: Alberto Lopez On 09/08/2025 at 12:47 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: VRAM ADULT FAMILY HOME
FACILITY NUMBER: 197802315

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/08/2025

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. The roof is in disrepair and licensee needs to repair, replace or get certification that the roof is sound which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 09/22/2025
Plan of Correction
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Licensee will repair, replace or get certification that the roof is sound and send proof to LPA by POC date.
Type B
Section Cited
CCR
80022(e)(4)
Plan of Operation
(e) If the licensee intends to admit or care for one or more clients who rely upon others to perform all activities of daily living, the plan of operation must also include a statement that demonstrates the licensee's ability to care for these clients. The evidence of ability may include but not be limited to: (4) Documentation of training the licensee and/or staff have completed specific to the needs of these clients.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, interview, record review, the licensee did not comply with the section cited above four(4) out of five (5) persons did not have the required ongoing training which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 09/22/2025
Plan of Correction
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Licensee will provide required yearly ongoing training to staff and send proof to LPA 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.
Lisa Hicks
NAME OF LICENSING PROGRAM MANAGER:
Alberto Lopez
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 09/08/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/08/2025


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
GREATER LA AC/SC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754
FACILITY NAME: VRAM ADULT FAMILY HOME
FACILITY NUMBER: 197802315
VISIT DATE: 09/08/2025
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(continued from 809)
3. Operational Requirement: The facility is licensed for four (4) ambulatory clients and currently all four (4) clients are ambulatory. The last fire/earthquake drill was conducted on 07/01/2025. Clients can attend community events/activities if there's an opportunity and chance. The facility has a shaded area with a table and chairs for clients to utilize the outdoor activity.

4.Staffing: The facility has sufficient staffing in place. LPA reviewed the NOC shift staff files, and staff have current CPR certificates on file.

5. Personnel Records-Training. The facility staff files are stored in facility, All the staff are over 18 years old and older, fingerprint cleared. The administrator is Vincent Lauretta, and his administrator certificate expiration date is 08/23/24 and he has proof that he has applied for renewal on 08/22/2024. LPA reviewed five (5) staff files, and four (4) files are all missing the training hours required.

6. Client right-Information: Currently there's no client who requires postural support. The facility also has internet service and provides at least one internet access device in the facility.

7. Client Records- Incident Reports: The client files are stored in the staff office in the file cabinet. All client files have the required documents including face sheet, admission agreement, functional capability assessment, health screening an TB Test, Individual Program Plan (IPP), ambulatory status and medication list.

8. Food Service: Currently no client is on a modified diet. The facility has two days perishable and seven (7) days non-perishable food supply. The food is stored probably. The facility refrigerator is maintained within the required temperature.

9. Health Related Services: The medication is centrally stored and locked in safe in a locked closet. LPA inspected three (3) clients medication, one (1) client does not take medications, and they were all updated and accurate at the time of visit. Clients all have 30 days’ supply of medication.

10.Incidental Medical Services: Currently there's no client who has any restricted health condition or prohibited health condition in the facility.

11. Disaster Preparedness: The facility has an emergency disaster plan dated 07/01/2025 and the last fire/emergency drill was conducted on 07/01/2025 and the facility has two alternative temporary shelter locations. LIC610 needs updating on location and instructions for shutting off utilities.

12. Emergency Intervention: The facility does not use any restraint on clients.

Deficiencies were observed during the visit. technical advisory was provided.

Exit Interview conducted and a copy of the report and appeal rights was provided to Alexis Valdez. Lead Staff.

NAME OF LICENSING PROGRAM MANAGER: Lisa Hicks
NAME OF LICENSING PROGRAM ANALYST: Alberto Lopez
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 09/08/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/08/2025
LIC809 (FAS) - (06/04)
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