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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197803548
Report Date: 07/27/2026
Date Signed: 07/27/2026 06:20:21 PM

Document Has Been Signed on 07/27/2026 06:20 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
CCLD Regional Office, 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: 4DATE:
07/27/2026
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:45 AM
MET WITH:Margaret Chen, Licensee / AdministratorTIME VISIT/
INSPECTION COMPLETED:
06:25 PM
NARRATIVE
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Licensing Program Analyst (LPA) Nune Margaryan conducted an annual required visit. LPA met with Administrator Margaret Chen. The purpose of the visit was explained. The facility is licensed to serve developmentally disable clients between the ages 18 to 59. Approved for four (4) ambulatory client. There are currently 4 clients residing at the home and receive services from Eastern Los Angeles Regional Center.
This one-story home is located in a residential area and consists of: living room, dining room,den, kitchen, laundry room, 2 client bedrooms, 2 bathrooms, 2 staff rooms, front and back yard and detached garage.
The physical plant was inspected along with medications, food supply, and client and staff records. LPA and Administrator toured the home and inspected client bedrooms, bathrooms, kitchen, dining room, living room, den, laundry room and garage. Closed for extra beddings observed in the hallway. There are no pools or large bodies of water. LPA observed that there is no shaded seating area observed for the clients.
Client bedrooms were checked. Each bedroom is equipped with the proper furnishings. Bedrooms also have sufficient closet space. The bathrooms were toured. The water temperature was tested in the bathrooms and measured 123.2 degrees F which in one of the bathroom,which is not within the required 105 - 120 degrees F. LPA observed in of clients bathroom sink not draining the water and there is no trash bin. Another bathroom has a trash bin but no cover. The kitchen was inspected. There is sufficient perishable food. LPA observed that there is not enough non-perishable food for one week. All the appliances are clean and working properly. Sharps were observed unlocked in a kitchen. LPA observed Electrical drill, several screws, razors various metal objects in the living room cabinet, in the kitchen cabinet drawers unlocked. Broken drawers were observed in the kitchen.

Continue 809C
Wei Siew Ho
Nune Margaryan
DATE: 07/27/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/27/2026
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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Document Has Been Signed on 07/27/2026 06:20 PM - It Cannot Be Edited


Created By: Nune Margaryan On 07/27/2026 at 04:21 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: CHEN'S HOME, INC.
FACILITY NUMBER: 197803548

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/27/2026

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
85087.2(b)
Outdoor Activity Space
(b) The outdoor activity area shall provide a shaded area, and shall be comfortable, and furnished for outdoor use.

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. During the inspection LPA observed that there was no shaded area or outdoor seathing available for clients, which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 08/03/2026
Plan of Correction
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Licensee / Administrator shall provide adequate shaded outdoor area and appropiate outdoor furniture for client use. Licensee shall submit photographs and / or receipts to the LPA before POC due date.
Type B
Section Cited
CCR
85076(d)(1)
Food Service
(d) The licensee shall meet the following food supply and storage requirements: (1) Supplies of staple nonperishable foods for a minimum of one week and fresh perishable foods for a minimum of two days shall be maintained on the premises.

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. LPA observed the facility does not have enough nonperishable food for minimum of one week seven (7) days, which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 07/31/2026
Plan of Correction
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Licensee / Administrator will purchase food and proof ( receipt, pictures) will be send to LPA brfore POC due 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.
Wei Siew Ho
NAME OF LICENSING PROGRAM MANAGER:
Nune Margaryan
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 07/27/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/27/2026


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
CCLD Regional Office, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754
FACILITY NAME: CHEN'S HOME, INC.
FACILITY NUMBER: 197803548
VISIT DATE: 07/27/2026
NARRATIVE
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Laundry detergent observed locked and inaccessible to clients. 2 fire extinguishers observed to be fully charged. Smoke/carbon monoxide detectors were observed to be fully operational. Clients medications were reviewed. Medications are centrally stored in cabinet located in the kitchen. Medications are documented properly and given as prescribed. The first aid kit was observed and found to be in compliance with the Title 22 Regulations. LPA reviewed client and staff files. All files are updated and staff working at the facility have fingerprint clearances. Last fire drill was conducted on 4/18/26.

Deficiencies were noted on LIC 809Ds.

Exit interview was conducted with Licensee /Administrator and a copy of this report and appeal rights were provided.
NAME OF LICENSING PROGRAM MANAGER: Wei Siew Ho
NAME OF LICENSING PROGRAM ANALYST: Nune Margaryan
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 07/27/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/27/2026
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 07/27/2026 06:20 PM - It Cannot Be Edited


Created By: Nune Margaryan On 07/27/2026 at 04:21 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: CHEN'S HOME, INC.
FACILITY NUMBER: 197803548

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/27/2026

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. LPA observed that one of clients bathroom sink is not draining water, kitchen cabinet drawer is broken, which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 08/03/2026
Plan of Correction
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Licensee / administrator will fix the vbroken drawer, repair the sink to ensure it is in a good working order and drains properly. Licensee shall submit proof of repairs and send a picture of proof to LPA via email before POC due date.
Type B
Section Cited
CCR
80088(f)(1)
Fixtures, Furniture, Equipment, and Supplies
(f) Solid waste shall be stored, located and disposed of in a manner that will not transmit communicable diseases or odors, create a nuisance, or provide a breeding place or food source for insects or rodents. (1) All containers, including movable bins, used for storage of solid wastes shall have tight-fitting covers kept on the containers; shall be in good repair, shall be leakproof and rodent-proof.

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. LPA observed that one bathroom doesn't have a trash bin and second bathroom trash bin doesn't have a cover which poses/posed a potential health, safety or personal rights risk to persons in care.

which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 08/03/2026
Plan of Correction
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Licensee / Administrator will buy 2 trash bins with the covers. Proof of correction ( pictures) will provided to LPA before POC due 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.
Wei Siew Ho
NAME OF LICENSING PROGRAM MANAGER:
Nune Margaryan
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 07/27/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/27/2026


LIC809 (FAS) - (06/04)
Page: 4 of 6
Document Has Been Signed on 07/27/2026 06:20 PM - It Cannot Be Edited


Created By: Nune Margaryan On 07/27/2026 at 04:21 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: CHEN'S HOME, INC.
FACILITY NUMBER: 197803548

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/27/2026

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
80087(g)(1)
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. (1) Storage areas for poisons, and firearms and other dangerous weapons shall be locked.

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. LPA observed the Electrical drill, several screws, raizors various metal objects in the living room cabinet, in the kitchen cabinet drawers unlocked, knifes and sissior were observed unlocked in a kitchen cabinet which poses an immediate health, safety or personal rights risk to persons in care.

POC Due Date: 07/27/2026
Plan of Correction
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Objects were removed and locked. Licensee / administrator shall ensure that all knifes / sharp objects will be locked and not accessible to clients. Administrator will provide training to staff regarding section 80087 and maintaining all knifes / sharp objects inaccessible to the clients by POC due date 07/31//26.
Type A
Section Cited
CCR
80088(e)(1)
Fixtures, Furniture, Equipment, and Supplies
(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. LPA inspected clients bathrooms and the hot water in one of the bathroom tested between 123.2 degrees F, which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 08/03/2026
Plan of Correction
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The Licensee / administrator will fix the hot water heater immediately and send the seven days hot water log to LPA by 08/03/26.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Wei Siew Ho
NAME OF LICENSING PROGRAM MANAGER:
Nune Margaryan
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 07/27/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/27/2026


LIC809 (FAS) - (06/04)
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