198600085-9-5-2025-28-AS-SMAN-DL8NYE-20250905105237

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 198600085
Report Date: 09/04/2025
Date Signed: 09/05/2025 10:54:18 AM

Document Has Been Signed on 09/05/2025 10:54 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK ASC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754

FACILITY NAME:	CHOICES R US - WOODHUE		FACILITY NUMBER:	198600085
ADMINISTRATOR/ DIRECTOR:	LY, LAN		FACILITY TYPE:	735
ADDRESS:	9523 WOODHUE ST		TELEPHONE:	(562) 942-1419
CITY:	PICO RIVERA	STATE: CA	ZIP CODE:	90660
CAPACITY: 6		CENSUS: 3	DATE:	09/04/2025
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	01:30 PM
MET WITH:	Lan Ly		TIME VISIT/ INSPECTION COMPLETED:	05:00 PM

NARRATIVE

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Licensing Program Analyst (LPA) Sakinah Madyun conducted an unannounced Required Annual Visit on 09/04/25. LPA Sakinah Madyun met with Quality Assurance/Administrator Gilbert Cardenas and explained the purpose for the visit. Administrator Lan Ly arrived shortly after and assisted with conducting the tour of the facility with LPA Sakinah Madyun along with Quality Assurance/Administrator Gilbert Cardenas and DSP Hernando Aragon. The facility is licensed to serve Developmentally Disabled Adults ages 18 to 59 years old and has a fire clearance approved for six (6) ambulatory clients. The facility is licensed as a level 4I home and all clients receive services from East Los Angeles Regional Center.

Physical Plant/Environment Safety: A tour of the single-story facility began at approximately 1:40pm that included residents’ rooms: three (3) client bedrooms, two (2) bathrooms, living room, staff area/dining area/laundry area/indoor activity, kitchen, and backyard. All residents’ bedrooms have the required furniture for privacy, comfort, and safety. LPA observed the carbon monoxide detector and smoke detectors throughout the facility. Fire extinguisher located in corner of kitchen wall fully charged last inspected 06/03/25. LPA observed two (2) first-aid kits were fully stocked and centrally stored locked in cabinet. LPA observed the Infection Control Plan and Emergency Disaster Plan last reviewed 06/25/25.

Front Yard: Was clean and well maintained without any hazards.

Infection Control practices and Personal Protective Equipment (PPEs) were observed. The facility still encourages hand washing, still checking client temperature twice a day and staff disinfected the facility every shift.

LIC 809C for continuation of report.

NAME OF LICENSING PROGRAM MANAGER: Lisa Hicks
NAME OF LICENSING PROGRAM ANALYST: Sakinah Madyun
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 09/04/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/04/2025

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
MONTEREY PARK ASC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754

FACILITY NAME: CHOICES R US - WOODHUE	FACILITY NUMBER: 198600085
	VISIT DATE: 09/04/2025

NARRATIVE

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Kitchen: LPA observed not enough perishables for two (2) days due to grocery shopping scheduled for 09/05/25 and more than enough seven (7) day supply of non-perishables. LPA observed knives and sharps locked away securely inaccessible to four (4) out of four (4) residents in care. LPA observed several bottles of cleaning solutions and disinfectants located in the bottom kitchen cabinet to be locked away securely inaccessible to four (4) out of four (4) residents in care. Kitchen appliance was observed to be clean and in working order. LPA observed fully charged fire extinguisher located on kitchen wall last inspected 06/03/25. Water temperature measured at 141.9 degrees Fahrenheit which is not within the range of 105.0-120 degrees Fahrenheit.

Dining Room/Living room: Dining room was observed to be clean with ample seating. The living room was observed with two (2) couch sets with ample seating and lighting. LPA observed the facility to be clean and appropriately furnished with clear passageways inside and outside.

Linen Closet: LPA observed hallway storage closet with sufficient linens and towels.

Bathrooms: Bathroom sinks and showers were free of mold/mildew. LPA observed that sufficient toiletries were accessible to clients. LPA observed bathroom #1 water temperature measured at 137.4 degrees Fahrenheit which is not within the range of 105.0 – 120 degrees Fahrenheit .Bathroom #2 water temperature measured at 119.3 which is within the range of 105.0 - 120 degrees Fahrenheit. LPA observed both bathrooms to be clean and in good condition and without the required non-slip mats.

Centrally Stored Medications: LPA observed storage cabinet for client medications and will return on a later date and time to review client medications and logs. Medications are stored, locked and inaccessible to clients.

Backyard: LPA observed a shaded seating area with ample seating. Backyard appeared to be clean and well maintained with no large bodies of water. Exit, walkways and/or passageways, front and back yard are free of debris and/or hazards.

Emergency Drills: LPA observed Emergency Fire and Earthquake Drill Log and drills are conducted every three months with the last fire drill conducted 06/25/25 and last earthquake drill conducted 08/26/25. Notifications and postings were observed which included personal rights, menu, and emergency disaster plan.

Staff Personnel Files: LPA will return a later date and time to interview staff and review files on a continuation visit.

Resident Files: LPA will return a later date and time to interview (4) clients and review (4) client medication logs on a continuation visit.

Infection Control Plan: The Administrator provided the Infection Control Plan and Emergency Disaster Plan during visit.

The following deficiency were cited according to The State of California Regulatory Codes, Title 22, Div. 6, Chapter 1(refer to Lic 809D).

Due to time constraint LPA will return a later date and time for a continuation visit. Exit interview was conducted with Administrator Lan Ly and a copy of this report and appeal rights will be provided.

NAME OF LICENSING PROGRAM MANAGER: Lisa Hicks
NAME OF LICENSING PROGRAM ANALYST: Sakinah Madyun
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 09/04/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/04/2025

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 09/05/2025 10:54 AM - It Cannot Be Edited

Created By: Sakinah Madyun On 09/04/2025 at 05:00 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
, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754

FACILITY NAME: CHOICES R US - WOODHUE	FACILITY NUMBER: 198600085
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 09/04/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type A

Section Cited

CCR

80088(e)(1)

Fixtures, Furniture, Equipment, and Supplies

(e) Faucets used by clients for personal care such as shaving and grooming shall deliver hot water. (1) Hot water temperature controls shall be maintained to automatically regulate temperature of hot water delivered to plumbing fixtures used by clients to attain a hot water temperature of not less than 105 degrees F (40.5 degrees C) and not more than 120 degrees F (48.8 degrees C). This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation, the licensee did not comply with the section cited above. The kitchen water temperature measured at 141.9 degrees Fahrenheit and bathroom #1 water temperature measured at 137.4 degrees Fahrenheit, which is not within the range of 105.0 – 120 degrees Fahrenheit, which poses an immediate health, safety or personal rights risk to persons in care.
	POC Due Date: 09/06/2025
	Plan of Correction
1 2 3 4	Licensee will create a tracking log for the next three (3) days and send video and photos via email to LPA of water temperature as proof of correction.

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.

	Lisa Hicks
NAME OF LICENSING PROGRAM MANAGER:

	Sakinah Madyun
NAME OF LICENSING PROGRAM ANALYST:

LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 09/04/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/04/2025

LIC809 (FAS) - (06/04)

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