198205039-7-20-2026-11-AS-BALN-DW72SL-20260720173920

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 198205039
Report Date: 07/20/2026
Date Signed: 07/20/2026 05:39:52 PM

Document Has Been Signed on 07/20/2026 05:39 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, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245

FACILITY NAME:	ANGEL'S HAVEN II		FACILITY NUMBER:	198205039
ADMINISTRATOR/ DIRECTOR:	OSCAR LECHUGA		FACILITY TYPE:	740
ADDRESS:	28022 ACANA ROAD		TELEPHONE:	(310) 544-4594
CITY:	RANCHO PALOS VERDES	STATE: CA	ZIP CODE:	90275
CAPACITY: 6		CENSUS: 4	DATE:	07/20/2026
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	02:00 PM
MET WITH:	Oscar Lechuga-Administrator		TIME VISIT/ INSPECTION COMPLETED:	05:55 PM

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On 07/20/2026, Licensing Program Analyst (LPA) Bernadette Allen conducted an unannounced visit to conduct the annual inspection. Upon arrival LPA met with support staff Floridalma Lechuga and Vicenta Mendoza who were explained the purpose of the visit.

The facility is licensed to serve six (6) residents ages 60 and over. Facility has been approved for six (6) Non-Ambulatory residents. The facility has been approved to retain (6) hospice residents. The fee’s are current.

The facility is a single-story home located in a residential neighborhood. It consists of (3) bedrooms, (2) full bathrooms, living room, dining room, kitchen, shaded back yard, front yard, laundry room and garage.

At 2:15 PM, LPA reviewed two (2) staff files for First Aid/CPR certification, criminal record clearance, training, and health screenings which all appeared to be current.

LPA reviewed four (4) residents files for admission agreements, updated physician reports, and needs and services plans which all appeared to be current. However, R4 is bedridden based on their physicians’ report dated 3/19/2026 and LPA observations. The facility is not licensed to care for bedridden residents nor is there an approved fire clearance.

At 3:30 PM, LPA observed that the facility appeared to be clean, sanitary, and appropriately furnished. Storage areas for personal hygiene items were in place. Cleaning supplies, toxins, and sharp objects were stored in a way that made them inaccessible to residents in care.

Stephanie Cifuentes
Bernadette Allen
	DATE: 07/20/2026

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/20/2026

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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245

FACILITY NAME: ANGEL'S HAVEN II	FACILITY NUMBER: 198205039
	VISIT DATE: 07/20/2026

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The bathrooms appeared to be clean with required handrails and non-slip mat, toilets and wash basin appeared to also be in good condition and operable.

The water temperature ranged from 105°F to 120. °F,

The kitchen was inspected, and there was a 5-day supply of perishable and a 7day supply of non-perishable food items which were adequately maintained/stored.

The fire extinguishers were fully charged; carbon monoxide detectors and smoke detectors were fully charged and operable. The last Fire/Disaster drills were conducted on June 3,2026.

Based on the observations and records reviewed made during today’s visit a deficiency was cited for caring for a bedridden resident without proper fire clearance.

An exit interview was conducted, and this report LIC809, 809-C and 809-D was discussed and provided to Oscar Lechuga- Administrator at the conclusion of the visit.

NAME OF LICENSING PROGRAM MANAGER: Stephanie Cifuentes
NAME OF LICENSING PROGRAM ANALYST: Bernadette Allen
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 07/20/2026

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/20/2026

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 07/20/2026 05:39 PM - It Cannot Be Edited

Created By: Bernadette Allen On 07/20/2026 at 05:04 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
, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245

FACILITY NAME: ANGEL'S HAVEN II	FACILITY NUMBER: 198205039
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 07/20/2026

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type A

Section Cited

CCR

87606(f)

Care of Bedridden Residents

(f) To accept or retain a person who is bedridden, a licensee shall ensure the following: This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on LPA observations and record review of R4 the licensee did not comply with the section cited above in 1 out of 4 residents is bedridden in a room that does not have a fire clearance approval which poses an immediate health, safety or personal rights risk to persons in care.
	POC Due Date: 07/21/2026
	Plan of Correction
1 2 3 4	The Licensee has agreed to temporarily relocate Resident #4 to the facility next door, Angels Home Care (Facility #198202004), and will apply for a bedridden fire clearance for Bedroom #3, which has an immediate exit door. The Licensee will take and submit a photo verifying Resident #4’s relocation by the POC due date of 7/21/2026. In addition, the Licensee will submit the LIC 200 Application to the Department on 7/21/2026 by the close of business.

Section Cited


	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

	Stephanie Cifuentes
NAME OF LICENSING PROGRAM MANAGER:

	Bernadette Allen
NAME OF LICENSING PROGRAM ANALYST:

LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 07/20/2026

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/20/2026

LIC809 (FAS) - (06/04)

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