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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197802923
Report Date: 10/23/2025
Date Signed: 10/23/2025 11:31:14 AM

Document Has Been Signed on 10/23/2025 11:31 AM - 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:MARYKNOLL HOMEFACILITY NUMBER:
197802923
ADMINISTRATOR/
DIRECTOR:		MARIA MADRIGALFACILITY TYPE:
735
ADDRESS:9024 MARYKNOLL AVENUETELEPHONE:
(562) 789-5800
CITY:WHITTIERSTATE: CAZIP CODE:
90605
CAPACITY: 6CENSUS: 6DATE:
10/23/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:30 AM
MET WITH:Michelle Puno, On-Call AdministratorTIME VISIT/
INSPECTION COMPLETED:
11:45 AM
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License Program Analyst (LPA), Mayra Cota, conducted an unannounced annual required visit today. LPA met with Martha Duenas, Direct Support Staff and the reason for the visit was explained. Michelle Puno, On-Call Administrator, arrived thereafter and continued to facilitate the visit.

The facility is licensed to serve (6) developmentally disabled adults ages 18 to 58, ambulatory only. The facility is operating within the scope if its license. Clients in care receive services through the Eastern Los Angeles Regional Center. The single story home is in a residential area of Whittier and consists of living room, office area, dining area, kitchen, entertainment room, (3) shared client bedrooms, (1) staff bedroom, (2) full bathrooms, laundry room, front and backyard, shaded patio area and detached garage.

During today's visit, LPA observed the following:

Facility was observed clean inside and out. Walkways, passages and exists are free of debris and obstructions. Living room and dining area have sufficient seating for clients and the furniture is in good repair. Kitchen appliances were observed clean and operable. Facility has a sufficient 2-day perishable and 7-day non-perishable supply of food which is kept labeled and properly stored. Sharps/knives and cleaning supplies are kept locked in a kitchen and in are inaccessible to clients. Bedrooms have the required furniture like bedframes, dressers, lamps, and chairs. Facility keeps clean linen, bath towels, and personal hygiene on hand in the hallway closets Both bathrooms were also observed clean and sanitary. Water temperature was tested in both bathrooms and measured at 107.6 and 107.2 degrees F, which is within compliance range.

***Continues on LIC 809-C .

NAME OF LICENSING PROGRAM MANAGER: Wei Siew Ho
NAME OF LICENSING PROGRAM ANALYST: Mayra Cota
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 10/23/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/23/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 3
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: MARYKNOLL HOME
FACILITY NUMBER: 197802923
VISIT DATE: 10/23/2025
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The front and backyard are well maintained, and backyard has a shaded patio area and patio furniture is in good repair. Garage is kept clean and free of clutter. Laundry room appliances are in good repair and were observed to be working properly. No pools or bodies of water were observed.

During visit, (4) client and (4) staff files were reviewed. Client files contain admission agreements, Physician Reports, medical/functional assessments, Appraisals/Needs and Services Plans, TB clearance, personal rights and consent forms. Staff files contain up to date First Aid/CPR certification, health screenings, criminal background clearances and training documentation.

Client medication was reviewed and found to be administered according to physicians’ orders and documented accordingly. Medication is centrally stored, locked and inaccessible to clients. Facility keeps PPE supplies on hand for staff and client use if needed. Emergency and Disaster Plan (LIC 610-D) was reviewed and is up to date. Facility conducts safety/fire drills every other month. Last drill was conducted on 10/4/25 with staff and client participation. Facility has a fire extinguisher in the kitchen and was observed charged and operable. Fire extinguisher was last serviced on 9/12/25. Combination smoke and carbon monoxide detectors were tested and were working properly.

During today’s visit, no deficiencies noted, per California Code of Regulations, Title 22, and California Health and Safety Code. Exit interview was conducted with Michelle Puno, On-Call Administrator, and a copy of the report was provided.

NAME OF LICENSING PROGRAM MANAGER: Wei Siew Ho
NAME OF LICENSING PROGRAM ANALYST: Mayra Cota
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 10/23/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/23/2025
LIC809 (FAS) - (06/04)
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