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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198600187
Report Date: 12/11/2025
Date Signed: 12/11/2025 04:44:46 PM

Document Has Been Signed on 12/11/2025 04:44 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
MONTEREY PARK ASC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754
FACILITY NAME:CHOICES R US - IZETTAFACILITY NUMBER:
198600187
ADMINISTRATOR/
DIRECTOR:		DANIEL GODFREYFACILITY TYPE:
735
ADDRESS:12103 IZETTA AVETELEPHONE:
(562) 869-5135
CITY:DOWNEYSTATE: CAZIP CODE:
90242
CAPACITY: 4CENSUS: 0DATE:
12/11/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:00 AM
MET WITH:Administrator- Shainna CatoTIME VISIT/
INSPECTION COMPLETED:
04:44 PM
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Licensing Program Analyst (LPA) Sakinah Madyun conducted an unannounced Required Annual Visit on 12/11/2025. LPA was met by Direct Support Professional Imunique Young and explained the purpose of the visit. Administrator Shainna Cato arrived shortly after. The facility is licensed to serve four (4) ambulatory residents between the age of 18 and 59 years old and vendored through South Central Regional Center. The home cares for both Developmentally Disabled clients.

Physical Plant/Environment Safety: A tour of the single-story building in a residential area was conducted approximately 9:10am, with a kitchen, dining room, living room, three (3) bedrooms, den/staff office area/activity area/laundry area, one (1) bathroom, and a backyard with a garage. All residents’ bedrooms have the required furniture for privacy, comfort, and safety. LPA observed the smoke and carbon monoxide detectors throughout the facility and two (2) fire extinguishers were fully charged last inspected 05/13/25.

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

Kitchen: LPA observed two (2) days of perishables and seven (7) days of non-perishables. LPA observed knives and sharps in the hallway cabinet to be locked away securely inaccessible to three (3) out of three (3) residents in care. LPA Madyun observed several bottles of cleaning solutions and disinfectants located in the hallway cabinet locked away securely inaccessible to three (3) out of three (3) residents in care. Kitchen appliances were observed to be clean and in working order. LPA observed two (2) fully charged fire extinguishers located on the kitchen wall and staff office area. Water temperature measured at 109.4 degrees Fahrenheit which is within the required 105-120 degrees Fahrenheit.

Continued LIC 809C

NAME OF LICENSING PROGRAM MANAGER: Lisa Hicks
NAME OF LICENSING PROGRAM ANALYST: Sakinah Madyun
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 12/11/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/11/2025
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 - IZETTA
FACILITY NUMBER: 198600187
VISIT DATE: 12/11/2025
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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.

Bathrooms: Bathroom is currently in good condition. LPA observed the water temperature measured at 108.0 degrees Fahrenheit which is within the required 105-120 degrees Fahrenheit.

Centrally Stored Medications: LPA observed medications being securely locked and inaccessible to residents. Due to time constraint LPA will return a later date and time for a continuation visit

Backyard: LPA observed a shaded seating area in the backyard near the garage. Backyard appeared to be clear and maintained with no large bodies of water.

Emergency Drills: Smoke detectors/carbon monoxide detectors were located throughout the facility, tested and operational. Emergency Fire and Earthquake Drills conducted every three (3) months last done 10/24/25.

Staff Personnel Files: LPA reviewed six (6) of six (6) staff files. LPA will return a later date and time to conduct staff interviews on a continuation visit.

Resident Files: LPA reviewed three (3) of three (3) resident files. LPA will return a later date and time to conduct residents interviews and review medication logs on a continuation visit.

Infection Control Plan: LPA observed an Infection Control Plan and Emergency Disaster Plan last revised and updated 10/26/24.

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

NAME OF LICENSING PROGRAM MANAGER: Lisa Hicks
NAME OF LICENSING PROGRAM ANALYST: Sakinah Madyun
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 12/11/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/11/2025
LIC809 (FAS) - (06/04)
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