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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197803548
Report Date: 08/12/2025
Date Signed: 08/12/2025 04:24:45 PM

Document Has Been Signed on 08/12/2025 04:24 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:CHEN'S HOME, INC.FACILITY NUMBER:
197803548
ADMINISTRATOR/
DIRECTOR:		CHEN, MARGARETFACILITY TYPE:
735
ADDRESS:5801 ALESSANDRO AVENUETELEPHONE:
(626) 456-0764
CITY:TEMPLE CITYSTATE: CAZIP CODE:
91780
CAPACITY: 4CENSUS: DATE:
08/12/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
02:15 PM
MET WITH:Margaret Chen, AdministratorTIME VISIT/
INSPECTION COMPLETED:
04:35 PM
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***This visit is a continuation from attempted annual visit conducted by LPA Cota on 8/12/25 at 8:32 a.m.***

Licensing Program Analyst, Mayra Cota, conducted an unannounced annual visit and met with Margaret Chen, Administrator. LPA was granted entry to the home and the reason for the visit was explained. The facility is licensed serve (4) ambulatory only, developmentally disabled clients 18-59 years old. The facility is operating within the scope of its license. All clients receive services through the Eastern Los Angeles Regional Center.

The one-story home is located in a residential area of Temple City and consists of: living room, dining room, kitchen, laundry room, (2) full bathrooms, (2) client bedrooms, (3) staff rooms, den, front and back yard and detached garage.

During today's visit, LPA observed the following:

· The indoor and outdoor premises of the facility were observed to be clean.
· Passageways, walkways, ramps and all exists are clear of debris and obstructions.
· The front and backyard are well maintained and there are no pools or large bodies of water.
· Shaded area located in the back yard is accessible to clients.
· The living room and den have adequate lighting, sufficient seating area and furniture is in good repair.
· Fireplace was observed covered in the living room.
***Report 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: 08/12/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/12/2025
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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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: CHEN'S HOME, INC.
FACILITY NUMBER: 197803548
VISIT DATE: 08/12/2025
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  • Kitchen was observed clean and sanitary for food storage and preparation of meals.
· Sufficient supply of 2-day perishable and 7-day non-perishable food was observed, and overflow in the laundry room also contained an extra supply of food.
· Kitchen appliances were observed clean and operable.
· Sharps/knives are kept locked in a kitchen cabinet and are inaccessible to clients in care.
· Laundry room washer and dryer are in good repair.
· Laundry room cabinet containing cleaning supplies, detergents and other toxins was observed locked.
· Client bedrooms have the required furniture such as bed frames, dressers, lamps, and chairs. Bedrooms also have sufficient closet space.
· Client beds have the required linen and mattress pads. There is a closet in the hallway area with extra clean linen and towels.
· Two full bathrooms were inspected and were observed clean. The water temperature was tested in both bathrooms and measured 105.6 in bathroom #1 and 119.1 in bathroom #3 which is within the required range of 105 - 120 degrees F.
· Facility has (4) fire extinguishers which were inspected and observed charged and operable.
· Combination smoke and carbon monoxide detectors were observed throughout the facility. They were tested and observed operable during the visit.
· Four (4) staff files were reviewed and staff have the required criminal background clearance.
· Four (4) client files were also reviewed and have the required documentation in place.
· Client medication is centrally stored and kept locked in a kitchen cabinet.
·Client medication was reviewed and was observed to be administered according to physician’s orders and documented appropriately.

No deficiencies noted during today's visit. Exit interview conducted with Margaret Chen, Administrator, and a copy of this report was provided.
NAME OF LICENSING PROGRAM MANAGER: Wei Siew Ho
NAME OF LICENSING PROGRAM ANALYST: Mayra Cota
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 08/12/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/12/2025
LIC809 (FAS) - (06/04)
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