198320504-1-26-2026-11-AS-ZBRN-DQPUT9-20260126145134

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 198320504
Report Date: 01/26/2026
Date Signed: 01/26/2026 02:51:44 PM

Document Has Been Signed on 01/26/2026 02:51 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:	CHEZ BON GUEST HOME		FACILITY NUMBER:	198320504
ADMINISTRATOR/ DIRECTOR:	IBRAHIM ZAYAT		FACILITY TYPE:	735
ADDRESS:	1206 WALNUT AVE		TELEPHONE:	(562) 591-1411
CITY:	LONG BEACH	STATE: CA	ZIP CODE:	90813
CAPACITY: 82		CENSUS: 77	DATE:	01/26/2026
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	08:15 AM
MET WITH:	Ibrahim Zayat (Adminstrator)		TIME VISIT/ INSPECTION COMPLETED:	03:00 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	On 01/26/2026 at 8:15am, Licensing Program Analyst (LPAs) Zina Brown conducted an unannounced annual required visit using the CARE Inspection Tool. LPAs met with the Ibrahim Zayat, Assistant Administrator and the purpose of today’s visit was explained. The facility is licensed to operate mentally disable clients ages 18 - 59 years, ambulatory clients only. Currently, the home has (77) clients. There are (6) FSP South Bay, (2) Mental Health of America and (77) non-private pay clients. None the clients have Restricted Health Care Conditions and none are utilizing postural supports or protective devices. The facility has a current administrator certificate (6069309735) for is Ibrahim Zayat (effective date 04/10/2024 & expires on 07/02/2026). The facility fees balance is at $0 and there is a active surety bond. The liability insurance is current as of 01/01/2026 with Kinsale Insurance and expires 01/01/2027 with general liability ($1,000,000) & general aggregate limit ($3,000,000) The facility is a two (2) story building located in a residential neighborhood. The property consists of the following: 22 apartments (each apartment has 3 bedrooms, 1 living room and 1 bathroom). The common areas include a kitchen with a dining area, an outdoor back yard, an outdoor shaded area, and a laundry room. The facility also staff office with reception area, a medication room and restroom. Between the hours of 8:20am - 11:00am, LPA conducted a records review of (8) client records, (8) staff records and,(8) Client Medication Administration Records and reviewed the facility disaster plan. The facility disaster plan was current and in compliance with Title 22 at the time of visit. The last fire drill was conducted on 12/02/2025 at 2:00pm. Report continues on LIC 809-C

NAME OF LICENSING PROGRAM MANAGER: Janae Hammond
NAME OF LICENSING PROGRAM ANALYST: Zina Brown
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 01/26/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/26/2026

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
EL SEGUNDO ASC, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245

FACILITY NAME: CHEZ BON GUEST HOME	FACILITY NUMBER: 198320504
	VISIT DATE: 01/26/2026

NARRATIVE

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Between the hours of 11:38am - 12:20pm, LPA, Ibrahim Zayat (Administrator) and Noam Sakoff (Assistant Administrator) toured the inside and outside of the facility. All client rooms were checked. Mattresses and box springs were in good condition, adequate lighting was observed , plenty of dresser and closet space was observed. Walls and floors were clean and in good repair. Bed linens, comforters and bath towels were adequately stocked at the time of visit. Bathrooms were found to be within Title 22 regulation. Toilets and water faucets worked properly. Shower was free of mold/mildew, there is adequate lighting, and sufficient toiletries accessible to clients. The water temperature properly measured between 105-120F in the kitchen (119.0F), in room 3 (107.0F), in room 8 (107.2F) and room 10 (107.0F)

Perishable and non-perishable food supply was checked and adequately stocked at time of visit. Carbon monoxide detector was observed and operational. Smoke detectors were working properly, fire extinguishers were fully charged. Medications were centrally stored and properly locked, first aid kit was checked and fully stocked. Outside grounds were toured and no bodies of water were observed. Exits/ Walkways around the home were free of debris and hazards.

During the annual inspection, LPA did observe a deficiency.

Deficiencies cited under California Code of Regulations (Title 22, Division 6, Chapter 8); LPA observed the following deficiencies: For 8 out 8 clients, LPA observed multiple medication discrepances for consecutive days such as: medication still inside the bubble pack yet it is documented in the medication administration record (MAR) that client received the medication.
the client received the medication, but on medication administration record (MAR) it is not documented.

Exit interview conducted with Ibrahim Zayat, Administrator, and a copy of this report was provided with appeal rights.

NAME OF LICENSING PROGRAM MANAGER: Janae Hammond
NAME OF LICENSING PROGRAM ANALYST: Zina Brown
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 01/26/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/26/2026

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 01/26/2026 02:51 PM - It Cannot Be Edited

Created By: Zina Brown On 01/26/2026 at 02:20 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: CHEZ BON GUEST HOME	FACILITY NUMBER: 198320504
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 01/26/2026

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

80075(b)

Health-Related Services

(b) Clients shall be assisted as needed with self-administration of prescription and nonprescription medications. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation, interview, & records review LPA observed medication discrepancies were found for 8 out of 8 clients such as: medications documented as given on the MAR remained in bubble packs, and medications given to clients were not documented on the MAR. The licensee did not comply with the cited section, posing a potential health and safety risk to persons in care.
	POC Due Date: 02/02/2026
	Plan of Correction
1 2 3 4	The facility will conduct an in-service training on how to properly administer medication and how to properly document on the Medication Administration Record (MAR) to adhere to Title 22 Regulation 80075 at all times. The licensee will ensure all staff receive in-service training by a licensed medical professional. Proof of correction must be sent to the department via email at zina.brown@dss.ca.gov

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.

	Janae Hammond
NAME OF LICENSING PROGRAM MANAGER:

	Zina Brown
NAME OF LICENSING PROGRAM ANALYST:

LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 01/26/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/26/2026

LIC809 (FAS) - (06/04)

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