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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197802583
Report Date: 03/23/2026
Date Signed: 03/23/2026 05:30:02 PM

Document Has Been Signed on 03/23/2026 05:30 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:SANTOS HOMEFACILITY NUMBER:
197802583
ADMINISTRATOR/
DIRECTOR:		LOURDES SANTOSFACILITY TYPE:
735
ADDRESS:11703 JAMES STREETTELEPHONE:
(562) 924-5149
CITY:CERRITOSSTATE: CAZIP CODE:
90703
CAPACITY: 4CENSUS: 4DATE:
03/23/2026
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
02:34 PM
MET WITH:Assistant Administrator Marhona AmadoTIME VISIT/
INSPECTION COMPLETED:
05:30 PM
NARRATIVE
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Licensing Program Analysts (LPA) Elena Mallett arrived at the facility for an unannounced Annual Visit and met with Assistant Administrator Marhona Amado and the purpose of the visit was explained. The facility is licensed to serve four developmentally disabled adults between the ages of 18 through 59. One may be non-ambulatory. The clients are served by Harbor Regional Center.

The facility is a single-story home, located in the residential area of Cerritos. The facility consists of a living room, dining area, family room, four (4) client bedrooms, one (1) staff bedroom (2) bathrooms, a kitchen,living /TV room, detached garage, and an outdoor shaded area with seating in the front yard.

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

Infection Control: Facility has an Infection Control Plan in place. Plan follows title 22 regulations. Staff has PPE supplies and are cleaning and disinfecting daily and practicing hand hygiene.

Physical Plant and Environmental Safety: Physical plant was clean and sanitary and free from debris and obstruction. Hot water temperature was measured in both client restrooms at 113 and 114 F which is within Title 22 regulations of 105F-120 F. Fire and CO2 detectors were tested and operational but room 3 had an incomplete smoke detector. A deficiency was cited. See 809D. A fully charged fire extinguisher was observed. Sharps ,poisons and toxins are in locked areas but a cleaning product was observed in an unlocked cabinet that was accessible to clients. A deficiency was cited. See 809-D. Required furniture and lighting was observed in each client bedroom Kitchen contained 2 days perishable and 7 day non-perishable food. Appliances were observed to be functional to store and prepare food. Food was stored separate from pesticides and toxins. The backyard was free from obstruction and debris and shaded patio furniture was observed in front yard.

NAME OF LICENSING PROGRAM MANAGER: Fernando Fierros
NAME OF LICENSING PROGRAM ANALYST: Elena Mallett
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 03/23/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/23/2026
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: SANTOS HOME
FACILITY NUMBER: 197802583
VISIT DATE: 03/23/2026
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Client bathrooms had operable toilets and sinks and showers made of no slip material.

Health Related Services: First Aid Kit and manual was observed. Emergency lighting was present.

Disaster Preparedness: Facility has a emergency disaster plan in place. Two relocation places are listed and emergency services numbers are included. Monthly disaster drills are conducted. Last drill conducted on 02/26/26.

Due to time constraints the remainder of the domains in the Care Tool will be completed on another day.

Deficiencies were cited today per Title 22 Regulations. An exit interview was conducted with Assistant Administrator Marhona Amado and a copy of this Licensing Report was provided along with Appeal Rights.

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

DATE: 03/23/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/23/2026
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 03/23/2026 05:30 PM - It Cannot Be Edited


Created By: Elena Mallett On 03/23/2026 at 05:11 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: SANTOS HOME
FACILITY NUMBER: 197802583

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/23/2026

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
80087(a)
Buildings 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: The smoke detector in Room 2 was not complete. This poses an immediate health and safety risk to 4 out of 4 clients in care.


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 1 out of 5 smoke detector was incomplete ( Room 2) which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 03/24/2026
Plan of Correction
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By POC due date Administrator will email a photo of an installed smoke detector in Room 2 to LPA.
Type A
Section Cited
CCR
80087(g)
Buildings 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: An bottle of cleaner was observed in an unlocked cabinet and was accesiable to clients in care.

Deficient Practice Statement
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Based on observation, the licensee did not comply with the section cited above in that a bottle of cleaner was observed in an unlocked cabinet that was accessiable to clients which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 03/24/2026
Plan of Correction
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Cleaner was placed in a locked cabinet during visit. By POC due date, Administrator will send to LPA via office fax a statement of understanding of the above regulation signed by all staff members.
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: 03/23/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/23/2026


LIC809 (FAS) - (06/04)
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