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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198203270
Report Date: 10/06/2025
Date Signed: 10/06/2025 05:15:03 PM

Document Has Been Signed on 10/06/2025 05:15 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
EL SEGUNDO ASC, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754
FACILITY NAME:HI-HOPES, INC.FACILITY NUMBER:
198203270
ADMINISTRATOR/
DIRECTOR:		HAI NGUYENFACILITY TYPE:
735
ADDRESS:16204 DAPHNE AVENUETELEPHONE:
(310) 323-8874
CITY:TORRANCESTATE: CAZIP CODE:
90504
CAPACITY: 6CENSUS: 4DATE:
10/06/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:38 PM
MET WITH:TIME VISIT/
INSPECTION COMPLETED:
05:00 PM
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On 10/06/25, Licensing Program Analyst (LPA), Wendy Gibbs conducted an unannounced Annual Visit to the facility listed above using the CAREs Tool. LPA met with Designee, Mariel Ventura Suarez and was later joined by Licensee, Hai Nguyen, and the purpose of today’s visit was explained. LPA was granted entry into the facility. The facility is licensed to serve six (6) developmentally disabled clients between ages of 18 to 59 year. They are approved for four (4) ambulatory and two (2) non-ambulatory residents.
Physical Plant/Structure The facility is a single-story structure in a residential neighborhood. The facility consists of the following, four (4) Client rooms, Office, Supply room, three (3) bathrooms, activity room/office, living room, kitchen, dining room, shaded area, outdoor activity area, laundry room and attached garage. All walkways outside were observed clean, clear, and free of debris, hazards, and obstructions. LPA did not observe any bodies of water on the premises.
Bedrooms LPA inspected all bedrooms and found them to be clean and in good repair. All client bedrooms had the required furniture, including a bed, dresser, nightstand, chair, and ample storage space for Client's personal belongings. All beds were observed with the required linens including a mattress cover, fitted sheets, blanket, comforter and pillows. All bedding was observed to be in good repair. LPA observed an ample supply of bed linens in a cabinet in the bathroom. All bedrooms had ample lighting.
Bathrooms LPA inspected all bathrooms and found them to be within Tittle 22 regulations. All bathrooms were observed clean and operational. LPA observed showers had nonskid mats, shower chairs available, and secured safety handrails. LPA observed an ample supply of towels and hygiene products in a closet in the bathroom. The water temperature measured 115.2-degrees, 114.7-degrees, and 114.8-degrees Fahrenheit.
Kitchen LPA inspected the kitchen and found it to be clean and sanitary. LPA observed all appliances to be operational and in good repair. LPA observed an ample supply of cookware, dishware, and cutlery in good
NAME OF LICENSING PROGRAM MANAGER: Eva M Alvarez
NAME OF LICENSING PROGRAM ANALYST: Wendy Gibbs
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 10/06/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/06/2025
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
EL SEGUNDO ASC, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754
FACILITY NAME: HI-HOPES, INC.
FACILITY NUMBER: 198203270
VISIT DATE: 10/06/2025
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repair. LPA observed a 3-day supply of perishable and a 7-day supply of non-perishable foods. All foods were observed properly stored and labeled. Sharps are secured in a locked cabinet in the laundry room. Cleaning supplies are secured in a locked cabinet under the kitchen sink. The water temperature measured 114.4-degrees Fahrenheit.
Common Rooms LPA inspected all common rooms and found it to be appropriately furnished. The facility was observed clean and in good repair. The activity room has a counter and cabinets with games, activities, and crafts. The dining room has a long and benches to accommodate all clients. The living room has two couches to accommodate all clients. LPA observed a screened fireplace that is inaccessible to clients. All rooms were observed with ample lighting. All walkways and hallways were observed clean, clear, and free of obstructions and hazards. The facility was maintained at a comfortable temperature.
Files LPA reviewed four (4) client files and found they contained the required documents. LPA reviewed the Client's P&I funds and logs and observed the receipts and amounts are consistent. LPA reviewed the administrator and three (3) staff files and found they contained the required documents, training, clearance, and certification. LPA reviewed the facilities Surety Bond through Nationwide Insurance Company is valid till 05/09/2027. Additionally, during file review, LPA observed the Licensing Fees are due on 10/24/2025 and PIN was provided to Licensee.
Medications All Centrally Stored Medications are secured in a locked cabinet in the activity room and are inaccessible to clients. LPA observed medications in their original packaging. LPA reviewed the medications and MARs for four (4) Clients and found they were consistent with properly documented records.
Safety LPA observed a fully charged fire extinguisher last serviced on 09/24/25. The last fire inspections from the Torrance Fire Department was conducted on 04/21/25. Smoke and carbon monoxide detectors are in compliance and are operational. The last emergency drill was conducted on 10/03/25. LPA inspected the First Aid kit and found it contained the required items and a manual. The facility has a landline telephone. LPA observed all required postings throughout the facility.
Infection Control LPA observed all required infection control signs posted throughout the facility. LPA observed sanitizing stations in the bathrooms and living room. LPA observed a 90-day supply of PPE's stored in the staff room and garage.
According to the California Code of Regulations (Tittle 22, Division 6, Chapter 8) LPA did not observe or cite any deficiencies.
An exit interview was conducted with Administrator, Mariel Ventura, and Licensee, Hai Nguyen, and a copy of this report was provided.
NAME OF LICENSING PROGRAM MANAGER: Eva M Alvarez
NAME OF LICENSING PROGRAM ANALYST: Wendy Gibbs
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 10/06/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

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