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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198600265
Report Date: 09/08/2025
Date Signed: 09/08/2025 05:11:23 PM

Document Has Been Signed on 09/08/2025 05:11 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
GREATER LA AC/SC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754
FACILITY NAME:ERNIE'S PLACEFACILITY NUMBER:
198600265
ADMINISTRATOR/
DIRECTOR:		GARCIA, NOEYFACILITY TYPE:
735
ADDRESS:630 N. NICHOLSONTELEPHONE:
(626) 280-7205
CITY:MONTEREY PARKSTATE: CAZIP CODE:
91755
CAPACITY: 6CENSUS: 5DATE:
09/08/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
02:39 PM
MET WITH:Alex Stott, Administrator TIME VISIT/
INSPECTION COMPLETED:
05:12 PM
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Licensing Program Analyst (LPA) Alberto Lopez conducted an unannounced Required - 1 year visit using the full Care Compliance and Regulatory Enforcement (CARE) Tools. LPA met with staff Jennifer Herren and explained the reason of the visit. Administrator Alex Stott arrived a short time later and assisted with the visit. The facility is approved for serve Developmentally Disabled Adults, six (6) ambulatory clients ages 18-59. Two (2) are over 60 years of age. The facility is licensed as a level 4D home vendored by the East Los Angeles Regional Center. Currently the facility has five (5) clients.

1. Infection Control: 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. The facility has an Infection Control Plan and COVID-19 mitigation plan in place.

2. Physical Environmental and Safety: The facility is a single story house and located on residential neighborhood area. The facility includes living room, kitchen, dining area, den/staff offices/client's activity room, Six (6) client bedrooms and 4 client bathrooms, laundry room and a detached garage. required furniture and bedding and sufficient lighting and closet space. The client bathrooms are clean, sanitary and in good working condition. The hot water was tested between 105.4 – 112.1 degrees F which is within the Title 22 regulation of 105.0 - 120.0 degrees F. The appliances in the living room and kitchen are working well. The knives and sharp utensils are stored and locked in the kitchen cabinet. All the chemicals and cleaning supplies are stored and locked in the laundry room and not accessible to clients. The extra linen and personal hygiene products are stored in the hallway cabinet/closet. The facility does have a working landline telephone system for clients to use. The facility has night lights. LPA inspected the carbon monoxide detectors, and all smoke detectors are working. The passageway, walkway and patio are free of obstruction. The facility has some damaged eves around the front of the house that needs to be addressed. The floor in the home is in the process of being replaced.

(Continued on 809C)

NAME OF LICENSING PROGRAM MANAGER: Lisa Hicks
NAME OF LICENSING PROGRAM ANALYST: Alberto Lopez
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 09/08/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/08/2025
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 6
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
GREATER LA AC/SC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754
FACILITY NAME: ERNIE'S PLACE
FACILITY NUMBER: 198600265
VISIT DATE: 09/08/2025
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(continued from 809)

3. Operational Requirement: The facility is licensed for 3 ambulatory and 3 non-ambulatory clients and currently two (2) clients are ambulatory. The last disaster/earthquake drill was conducted on 09/08/2025. Clients can attend community events/activities if there's an opportunity and chance. The facility has a shaded area with tables and chairs for clients to utilize the outdoor activity.

4.Staffing: The facility has sufficient staffing. LPA reviewed the NOC shift staff files, and he does have a current CPR/FIRST AID certificate.

5. Personnel Records-Training. The facility staff files are stored at the facility. All the staff are over 18 years old and older, fingerprint cleared and associated with the facility. The administrator is Alex Stott and his administrator certificate expiration date is 12/08/2026 and he has updated HIV and TB training. LPA reviewed four (4) staff files, and they all have health screening TB test results and ongoing yearly training.

6. Client right-Information: Currently there's no client that requires postural support. The facility has internet service and provides at least one internet access device in the facility.

7. Client Records- Incident Reports: The client files are stored in the staff office in the file cabinet. All client files have the required documents including face sheet, admission agreement, functional capability assessment, health screening TB Test, Individual Program Plan (IPP), ambulatory status and medication list.

8. Food Service: Currently no client is on a modified diet. The facility does have seven (7) days non- perishable food and 2 day perishable food supply. The food is stored probably. The facility refrigerator is maintained within the required temperature. Some perishable food was found to be spoiled on 08/27/2025 and was promptly discarded and replaced.

9. Health Related Services: The medication is centrally stored and locked in a cabinet. LPA inspected four (4) clients medication files, and they were all updated and accurate at the time of visit. They all have 30 days’ supply of medication.

10.Incidental Medical Services: Currently there's no client who has any restricted health condition or prohibited health condition in the facility.

11. Disaster Preparedness: The facility has an emergency disaster plan and the last fire/emergency drill was conducted on 06/04/2025 and the facility has two alternative temporary shelter locations.

12. Emergency Intervention: The facility does not use any restraint on clients.

No deficiencies were not observed during the visit. Technical Advisories provided.

Exit Interview conducted and a copy of the report was provided to Alex Stott

NAME OF LICENSING PROGRAM MANAGER: Lisa Hicks
NAME OF LICENSING PROGRAM ANALYST: Alberto Lopez
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 09/08/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/08/2025
LIC809 (FAS) - (06/04)
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