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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198320463
Report Date: 10/19/2025
Date Signed: 10/19/2025 02:29:57 PM

Document Has Been Signed on 10/19/2025 02:29 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:BRANVILLE HOMESFACILITY NUMBER:
198320463
ADMINISTRATOR/
DIRECTOR:		JONES, BRANDONFACILITY TYPE:
735
ADDRESS:8901 LA SALLE AVENUETELEPHONE:
(310) 245-6865
CITY:LOS ANGELESSTATE: CAZIP CODE:
90047
CAPACITY: 4CENSUS: 4DATE:
10/19/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:35 AM
MET WITH:Noelle Smith, LicenseeTIME VISIT/
INSPECTION COMPLETED:
02:45 PM
NARRATIVE
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On 10/19/25 at 8:35AM, Licensing Program Analyst (LPA) Gina Saucedo, arrived to conduct an unannounced, annual inspection at the facility. Upon arrival, LPA Saucedo met with DSP-Direct Support Professional, . The Licensee Noelle Smith, was called and arrived about thirty (30) minutes after.

LPA asked for the census, client, and staff files. A physical tour was conducted at 9:30am and observed the following: Currently, there are three (3) ambulatory clients and one (1) bedridden client ranging from ages 18 through 62. The facility is not cleared to have a bedridden client. Facility is cleared to have two (2) ambulatory and two (2) non-ambulatory.

The Kitchen area was toured, and LPA observed there to be sufficient seven (7) day supply of non-perishable foods and perishable food for all clients. The kitchen area was clean at the time of the tour. There is a refrigerator and a stove that are operable. The washer and dryer are located next to the kitchen in a separate area. The knives/sharps are located in the kitchen area accessible to the clients. The chemicals/toxins are locked and inaccessible to the clients in this area on the top cabinets. There are cabinets that have extra food.

The fire extinguisher is located against the wall on your right-hand side of the dining hall leading to the kitchen area fully charged and dated August 2024. The medication is also locked and inaccessible to the clients in the living/dining room area in a cabinet where the files are also located.

LIC 809C-continued
NAME OF LICENSING PROGRAM MANAGER: Eva M Alvarez
NAME OF LICENSING PROGRAM ANALYST: Gina Saucedo
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 10/19/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/19/2025
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 10
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)
Page: 2 of 10
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: BRANVILLE HOMES
FACILITY NUMBER: 198320463
VISIT DATE: 10/19/2025
NARRATIVE
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Outside/Backyard: The outside/backyard does not have furniture for clients and staff. The facility has no pool or bodies of water. There is a garage that is detached from the house and used as a storage area.

Bedrooms and Bathrooms: There are four (4) bedrooms and two (2) bathrooms. The four (4) bedrooms are as follows-All bedrooms are single occupied. One (1) bedrooms has a private bathroom. All bedrooms and bathrooms were toured and were properly furnished and have appropriate bedding, linens, toiletry and lightning. The bathrooms have proper toiletry and grab bars. The bathroom's water temperature was within regulations reading between 113.5 and 119 degrees Fahrenheit.

The dining area/living room area has enough seating for the clients and the staff. There is a large projectable television against the wall of the entrance of the facility on your left-hand side.

The carbon monoxide and smoke detectors are located throughout the facility and are operable and interconnected. The house temperature is set at 73 degrees.

Administrative: The insurance plan is updated and is dated 04/2026. The last fire/earthquake and disaster drill has not been conducted. There is one (1) transportation vehicle used to transport the client/s. There are cameras in the common areas of the house and a signal system.

Staff and Client Files were reviewed. LPA reviewed four (4) client files and three (3) staff files were reviewed. Four (4) out of four (4) files were missing client tuberculosis. Three (3) clients files were missing Physician's Report. One (1) client is missing Admission's Agreement. Two (2) of three (3) staff did not have CPI-Crisis Prevention Intervention, One (1) staff did not have CPR/First aid, One (1) of three (3) staff did not have a health screening and clearance of tuberculosis, there was no staff training in records and a visitor was providing care and supervision.

An exit interview was conducted, several citation(s) were issued, and a copy of this report was given to the administrator/Licensee with appeals rights.
NAME OF LICENSING PROGRAM MANAGER: Eva M Alvarez
NAME OF LICENSING PROGRAM ANALYST: Gina Saucedo
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 10/19/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/19/2025
LIC809 (FAS) - (06/04)
Page: 3 of 10
Document Has Been Signed on 10/19/2025 02:29 PM - It Cannot Be Edited


Created By: Gina Saucedo On 10/19/2025 at 11:45 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
, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245

FACILITY NAME: BRANVILLE HOMES
FACILITY NUMBER: 198320463

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/19/2025

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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3
4
Based on the observation the licensee did not comply with the section cited above in storing knives/sharps which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 10/20/2025
Plan of Correction
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2
3
4
The Licensee/Administrator shall store knives/sharps immediately to prevent danger to others.
Type A
Section Cited
CCR
80010(b)
Limitations on Capacity and Ambulatory Status
(b) Facilities or rooms approved for ambulatory clients only shall not be used by nonambulatory clients.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation and record review the licensee did not comply with the section cited above in one (1) client's physical status which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 10/20/2025
Plan of Correction
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The Licensee/Administrator shall follow LIC 850 from the fire department and/or get another LIC 850 giving clearance.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Eva M Alvarez
NAME OF LICENSING PROGRAM MANAGER:
Gina Saucedo
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 10/19/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/19/2025


LIC809 (FAS) - (06/04)
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Document Has Been Signed on 10/19/2025 02:29 PM - It Cannot Be Edited


Created By: Gina Saucedo On 10/19/2025 at 11:45 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
, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245

FACILITY NAME: BRANVILLE HOMES
FACILITY NUMBER: 198320463

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/19/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
80020(a)
Fire Clearance
(a) All facilities shall secure and maintain a fire clearance approved by the city or county fire department, the district providing fire protection services, or the State Fire Marshal.

This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on the observation and record review the licensee did not comply with the section cited above in having a bedridden client which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 10/20/2025
Plan of Correction
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2
3
4
The Licensee/Administrator shall follow LIC 850 from the fire department and/or get another LIC 850 giving clearance for a bedridden client.
Type A
Section Cited
CCR
80078(a)
Responsibility for Providing Care and Supervision
(a) The licensee shall provide care and supervision as necessary to meet the client's need.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on the observation the licensee did not comply with the section cited above in one (1) bedridden client which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 10/20/2025
Plan of Correction
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The licensee/Administrator shall provide the necessary need to meet the care and supervision of the bedridden client. The visitor was providing care and supervision to this client.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Eva M Alvarez
NAME OF LICENSING PROGRAM MANAGER:
Gina Saucedo
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 10/19/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/19/2025


LIC809 (FAS) - (06/04)
Page: 5 of 10
Document Has Been Signed on 10/19/2025 02:29 PM - It Cannot Be Edited


Created By: Gina Saucedo On 10/19/2025 at 11:45 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
, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245

FACILITY NAME: BRANVILLE HOMES
FACILITY NUMBER: 198320463

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/19/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
80077.3(a)(3)(C)
Care for Clients who Lack Hazard Awareness or Impluse Control
(C) Following the disaster and mass casualty plan specified in Section 80023, fire and earthquake drills shall be conducted at least once every three months on each shift and shall include, at a minimum, all facility staff who provide or supervise client care and supervision.

This requirement is not met as evidenced by:
Deficient Practice Statement
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3
4
Based on the record review the licensee did not comply with the section cited above in there has been no fire and earthquake drills since the opening/every three months for the facility which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 11/03/2025
Plan of Correction
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The Licensee/Administrator shall conduct every months a fire and earthquake drill and place it in the facility binder.
Type B
Section Cited
CCR
85064(k)
Administrator Qualifications and Duties
(k) Within six months of becoming an administrator, the individual shall receive training on HIV and TB required by Health and Safety Code Section 1562.5. Thereafter, the administrator shall receive updated training every two years.

This requirement is not met as evidenced by:
Deficient Practice Statement
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4
Based on the record review the licensee did not comply with the section cited above in there was no training pertaining to HIV and TB from the administrator on file which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 11/03/2025
Plan of Correction
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4
The Licensee/Administrator shall conduct HIV and TB training and place it in their administator/Licensee file.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Eva M Alvarez
NAME OF LICENSING PROGRAM MANAGER:
Gina Saucedo
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 10/19/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/19/2025


LIC809 (FAS) - (06/04)
Page: 6 of 10
Document Has Been Signed on 10/19/2025 02:29 PM - It Cannot Be Edited


Created By: Gina Saucedo On 10/19/2025 at 11:45 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
, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245

FACILITY NAME: BRANVILLE HOMES
FACILITY NUMBER: 198320463

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/19/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
80066(a)(10)
Personnel Records
(a) The licensee shall ensure that personnel records are maintained on the licensee, administrator and each employee. Each personnel record shall contain the following information: (10) A health screening as specified in Section 80065(g).

This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on the record review the licensee did not comply with the section cited above in one (1) staff did not have a health screening signed by a physician/doctor which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 11/03/2025
Plan of Correction
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2
3
4
The licensee/administrator shall have the health screening signed by a physician/doctor and put in the staff's file.
Type B
Section Cited
CCR
80066(a)(11)
Personnel Records
(a) The licensee shall ensure that personnel records are maintained on the licensee, administrator and each employee. Each personnel record shall contain the following information: (11) Tuberculosis test documents as specified in Section 80065(g).

This requirement is not met as evidenced by:
Deficient Practice Statement
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2
3
4
Based on the record review the licensee did not comply with the section cited above in the tuberculois of one of the staff was not present at the time of the file review which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 11/03/2025
Plan of Correction
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2
3
4
The licensee/administrator shall have the tuberculosis of the staff in the staff's file.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Eva M Alvarez
NAME OF LICENSING PROGRAM MANAGER:
Gina Saucedo
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 10/19/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/19/2025


LIC809 (FAS) - (06/04)
Page: 7 of 10
Document Has Been Signed on 10/19/2025 02:29 PM - It Cannot Be Edited


Created By: Gina Saucedo On 10/19/2025 at 11:45 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
, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245

FACILITY NAME: BRANVILLE HOMES
FACILITY NUMBER: 198320463

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/19/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
85065(b)
Personnel Requirements
(b) The licensee shall employ staff as necessary to ensure provision of care and supervision to meet client needs.

This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on the observation the licensee did not comply with the section cited above in there is no staff training to provide for the care and supervision of each client which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 11/03/2025
Plan of Correction
1
2
3
4
The licensee/Administrator -The staff's training shall be put in their each staff's file upon the staff receiving the proper training to provide accurate care and supervision of each client.
Type B
Section Cited
CCR
80068(a)
Admission Agreements
(a) The licensee shall complete an individual written admission agreement with each client and the client's authorized representative, if any.

This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on the record review the licensee did not comply with the section cited above in one (1) client was missing their admission agreement which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 11/03/2025
Plan of Correction
1
2
3
4
The licensee/Administrator shall put the admission agreement of the client in their file and send a copy to LPA.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Eva M Alvarez
NAME OF LICENSING PROGRAM MANAGER:
Gina Saucedo
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 10/19/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/19/2025


LIC809 (FAS) - (06/04)
Page: 8 of 10
Document Has Been Signed on 10/19/2025 02:29 PM - It Cannot Be Edited


Created By: Gina Saucedo On 10/19/2025 at 11:45 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
, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245

FACILITY NAME: BRANVILLE HOMES
FACILITY NUMBER: 198320463

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/19/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
80069(c)
Client Medical Assessments
(c) The medical assessment shall include the following:

This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on the record review the licensee did not comply with the section cited above in three client physician's report which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 11/03/2025
Plan of Correction
1
2
3
4
The Licensee/Administrator shall provide a copy of each client's physician's report and put it in their file and send a copy to LPA.
Type B
Section Cited
CCR
80069(c)(1)
Client Medical Assessments
(c) The medical assessment shall include the following: (1) The results of an examination for communicable tuberculosis and other contagious/infectious diseases.

This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on the record review the licensee did not comply with the section cited above in four clients did not have their tubercolosis which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 11/03/2025
Plan of Correction
1
2
3
4
The Licensee/Administrator shall provide a copy of each client's tuberculosis and put it in their file and send a copy to LPA.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Eva M Alvarez
NAME OF LICENSING PROGRAM MANAGER:
Gina Saucedo
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 10/19/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/19/2025


LIC809 (FAS) - (06/04)
Page: 9 of 10
Document Has Been Signed on 10/19/2025 02:29 PM - It Cannot Be Edited


Created By: Gina Saucedo On 10/19/2025 at 12:25 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: BRANVILLE HOMES
FACILITY NUMBER: 198320463

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/19/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
85165(b)(2)
(b) Staff who use, participate in, approve or provide visual checks of manual restraint or seclusion, shall have a minimum of sixteen hours of emergency intervention training and be certified for having successfully completed the training. Staff shall be certified in CPI

This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on the record review the licensee did not comply with the section cited above in two (2) staff that were present at the time of the visit did not have CPI training which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 11/03/2025
Plan of Correction
1
2
3
4
The Licensee/Administrator shall have both staff conduct CPI Training and put it in their file.
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.
Eva M Alvarez
NAME OF LICENSING PROGRAM MANAGER:
Gina Saucedo
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 10/19/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/19/2025


LIC809 (FAS) - (06/04)
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