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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198204999
Report Date: 05/23/2026
Date Signed: 05/23/2026 12:00:29 PM

Document Has Been Signed on 05/23/2026 12:00 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,
, CA
FACILITY NAME:AMERICARE ASSISTED LIVING OF WESTCHESTERFACILITY NUMBER:
198204999
ADMINISTRATOR/
DIRECTOR:		PATRICK BAUTISTAFACILITY TYPE:
740
ADDRESS:8501 RAMSGATE AVENUETELEPHONE:
(310) 641-5808
CITY:LOS ANGELESSTATE: CAZIP CODE:
90045
CAPACITY: 6CENSUS: 6DATE:
05/23/2026
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:02 AM
MET WITH:Leia Joaquin, LicenseeTIME VISIT/
INSPECTION COMPLETED:
12:00 PM
NARRATIVE
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Licensing Program Analyst (LPA) N. Galarza arrived at the facility unannounced for the purpose of conducting the Required 1-Year annual evaluation. LPA was greeted and granted entry by caregiver staff Christina Sevilla. Licensee Leia Joaquin arrived later on to assist with inspection. Administrator has a valid administrator's certificate expiring on 1/5/2027.

The following was observed during the inspection:

Infection Control: The Infection Control Plan includes Environmental cleaning and disinfection activities.

Operational Requirements: A Dementia and hospice waiver for 2 residents is approved. A fire clearance for 4 non-ambulatory adults 60 and over, and two (2) bedridden [rooms 4 & 5]residents 60 years and over. Facility does not handle resident P & I monies. Liability Insurance in the amount of at least ($1,000,000) per occurrence and ($3,000,000) in total annual aggregate is current with an expiration date of 12/9/2026.

Physical Plant/Environment Safety: The interior and exterior physical plant was inspected. The facility is a two-story home located in a residential area consisting of one (1) 2nd floor staff bedroom, six (6) bedrooms, three (3) full bathrooms, one (1) half bathroom, kitchen, dining room, living room, laundry area, attached garage, and backyard with patio area. Rooms are equipped with required furniture and bedding. Cleaning supplies and toxic substances are inaccessible to residents. The facility has three fire extinguishers. Fire sprinklers, fire pull alarm, and electrical smoke and carbon monoxide detectors are operational. The facility maintains emergency food supply and water. Emergency Phone numbers, exit plan and programming schedules were posted. The building contains central air conditioning and heating. The facility has a first aid kits/Manuals that consist of thermometer, tweezers, scissors, antiseptic, bandages, gauze. Exit doors are free of any obstruction. The last Emergency Disaster drill was conducted on 5/7/2026.

Deficiencies observed: Water temperature readings measured did not test within the required 105 - 120 degrees Fahrenheit.There was a knife on the counter, a pair of scissors on top of the sink counter, and another pair of scissors in an unlocked kitchen drawer. Resident (R1's) bed has full bed rails but the resident is not currently enrolled in hospice care. The facility sketch and plan of operation are not updated.

NAME OF LICENSING PROGRAM MANAGER: Wei Siew Ho
NAME OF LICENSING PROGRAM ANALYST: Noemi Galarza
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 05/23/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/23/2026
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
CCLD Regional Office,
, CA
FACILITY NAME: AMERICARE ASSISTED LIVING OF WESTCHESTER
FACILITY NUMBER: 198204999
VISIT DATE: 05/23/2026
NARRATIVE
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Staffing: A total 8 staff members provide care and supervision to the residents.

Personnel Records/Staff Training: Staff have criminal background clearance and training. Six (6) staff files were reviewed. Proof of staff training, health clearance, and 1st Aid/CPR training is current in files.

Resident Records/Incident Reports: A total of six (6) resident files were reviewed. They contained admission agreements, Physician's Reports, Appraisals, TB clearance, Physician's Orders, medical consent.

RCFE complaint poster and Personal rights were observed posted. The poster is not 20 x 26 in size. A technical advisory.

Planned Activities: Sufficient space to accommodate both indoor and outdoor activities was observed. The facility does not have a Resident Council.

Food Service: Sufficient food supply is stored in the kitchen and pantry areas consisting of: 2-day perishables, 7-day non-perishables, and emergency food supplies. Two residents have modified diets.

Incident Medical and Dental: Centrally stored / 30-Day supply of medications were reviewed. Medical and dental transportation is provided by family.

*Two medication containers were observed unlocked on top of the counter next to breakfast meals and a kitchen drawer had 4 unlocked medication cups and Advair medications.

Disaster Preparedness: Emergency and Disaster Plan LIC 610E was reviewed. Facility has a First Aid Kit and Manual.

Residents with Special Health Needs: One (1) resident receives hospice services and there are currently no residents receiving home health care. Two residents are bedridden.

*Resident (R1's) bed has full bed rails but the resident is not currently enrolled in hospice care. Half rails were installed during the visit.

Pursuant to Title 22, deficiencies are cited.


An exit interview was conducted with Licensee Leia Joaquin. A copy of the report and appeal rights were issued.
NAME OF LICENSING PROGRAM MANAGER: Wei Siew Ho
NAME OF LICENSING PROGRAM ANALYST: Noemi Galarza
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 05/23/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/23/2026
LIC809 (FAS) - (06/04)
Page: 3 of 6
Document Has Been Signed on 05/23/2026 12:00 PM - It Cannot Be Edited


Created By: Noemi Galarza On 05/23/2026 at 10:59 AM
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
,
, CA

FACILITY NAME: AMERICARE ASSISTED LIVING OF WESTCHESTER
FACILITY NUMBER: 198204999

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/23/2026

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
87303(e)(2)
Maintenance and Operation
(2) Faucets used by residents for personal care such as shaving and grooming shall deliver hot water. Hot water temperature controls shall be maintained to automatically regulate the temperature of hot water used by residents to attain a temperature of not less than 105 degree F (41 degrees C) and not more than 120 degree F (49 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 in that the water temperature readings were 128.3 DF, 125.1 DF, 124.1 DF, which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 05/24/2026
Plan of Correction
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Licensee agreed to submit a hot water temperature log by tomorrow. Staff shall test the water during each shift.
Type A
Section Cited
CCR
87309(a)
Storage Space and Access
(a) Except as specified in subsection (b), the licensee shall ensure that disinfectants, cleaning solutions, poisonous substances, knives, matches, tools, sharp objects, and other similar items which could pose a danger to residents are in locked storage and are not left unattended if outside the locked storage.

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 that there was a knife on the counter, a pair of scissors on top of the sink counter, and another pair of scissors in an unlocked kitchen drawer, which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 05/24/2026
Plan of Correction
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License agreed to conduct in-service training in 87309. The sharp items were immediately locked.
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:
Noemi Galarza
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 05/23/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/23/2026


LIC809 (FAS) - (06/04)
Page: 4 of 6
Document Has Been Signed on 05/23/2026 12:00 PM - It Cannot Be Edited


Created By: Noemi Galarza On 05/23/2026 at 10:59 AM
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
,
, CA

FACILITY NAME: AMERICARE ASSISTED LIVING OF WESTCHESTER
FACILITY NUMBER: 198204999

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/23/2026

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
87465(h)(2)
Incidental Medical and Dental Care Services
(h) The following requirements shall apply to medications which are centrally stored: (2) Centrally stored medicines shall be kept in a safe and locked place that is not accessible to persons other than employees responsible for the supervision of the centrally stored medication.

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 that 2 medication containers were observed unlocked on top of the counter next to breakfast meals and a kitchen drawer had 4 unlocked medication cups and Advair medications, which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 05/24/2026
Plan of Correction
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Licensee agreed to submit proof of staff in-service training in 87465.
Type A
Section Cited
CCR
87608(a)(5)(B)
Postural Supports
(B) Bed rails that extend the entire length of the bed are prohibited except for residents who are currently receiving hospice care and have a hospice care plan that specifies the need for full bed rails.

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 resident (R1's) bed has full bed rails but the resident is not currently enrolled in hospice care, which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 05/24/2026
Plan of Correction
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Licensee agreed to submit a written plan of correction by tomorrow. Submit the half bed rail physician order by Tue. May. 26, 2026, as this is a holiday weekend.

During the visit, staff adjusted the bed rail to a half rail.
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:
Noemi Galarza
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 05/23/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/23/2026


LIC809 (FAS) - (06/04)
Page: 5 of 6
Document Has Been Signed on 05/23/2026 12:00 PM - It Cannot Be Edited


Created By: Noemi Galarza On 05/23/2026 at 10:59 AM
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
,
, CA

FACILITY NAME: AMERICARE ASSISTED LIVING OF WESTCHESTER
FACILITY NUMBER: 198204999

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/23/2026

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
87208(a)
Plan of Operation
(a) The licensee shall have and maintain a current, written definitive plan of operation for the facility. The licensee shall operate the facility in accordance with the terms specified in the plan of operation and may be cited for not doing so pursuant to Health and Safety Code section 1569.49. The plan and related materials shall be on file in the facility and shall be submitted to the licensing agency with the license application. Any significant changes in the plan of operation which would affect the services to residents shall be submitted to the licensing agency for approval. The plan and related materials shall contain the following:

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, the licensee did not comply with the section cited above in that the Licensee allows staff to sleep overnight, and some staff are allowed to bring their elderly parent and son during work hours. They sleep at the facility when the staff work, the plan of operation does not include live-in staff accommodations and the facility sketch is not current, and does not list the 2nd floor bedroom, which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 06/08/2026
Plan of Correction
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Licensee agreed to:
1.Submit an updated plan of operation to reflect the 2nd floor staff bedroom use.
2. Submit an updated facility sketch
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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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:
Noemi Galarza
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 05/23/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/23/2026


LIC809 (FAS) - (06/04)
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