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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198600271
Report Date: 05/21/2026
Date Signed: 05/22/2026 07:05:36 AM

Document Has Been Signed on 05/22/2026 07:05 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:HAMILTON VILLAFACILITY NUMBER:
198600271
ADMINISTRATOR/
DIRECTOR:		ADELA SANTOSFACILITY TYPE:
735
ADDRESS:948 SOUTH HAMILTON BLVD.TELEPHONE:
(909) 620-1933
CITY:POMONASTATE: CAZIP CODE:
91766
CAPACITY: 84CENSUS: 60DATE:
05/21/2026
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:40 AM
MET WITH:Adela Santos, Administrator TIME VISIT/
INSPECTION COMPLETED:
02:15 PM
NARRATIVE
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Licensing Program Analysts (LPA) Gabriela Castro conducted an unannounced required annual visit using the Compliance and Regulatory Enforcement (CARE) Tool. LPAs were greeted by Adela Santos, Administrator and explained the purpose of the visit.

The facility is licensed to serve clients between the ages of 18 to 59 and is approved for up to six (6) non-ambulatory clients. At time of visit the facility is serving mentally ill clients and census consisted of 60 clients.

FACILITY TOUR AND OBSERVATIONS:

Personal Rights postings were not observed in a common areas. Residents had access to personal space, privacy, and adequate storage. No firearms/weapons were present.

Physical Plant

The facility is located in a residential area on a busy street and consists of four (4) single-story buildings which accommodate twelve (12) client rooms each. Building B contains the kitchen/dining area and one (1) staff room. There is an additional building which contains the medication room, offices, conference room, two (2) storage rooms for maintenance and supplies, and a laundry room. All bedrooms contained the required furnishings, including beds, linens, dressers, and adequate lighting. Additional clean linens and towels were observed stored in the laundry room. The maintenance/storage area was observed to be locked. Cleaning supplies located in the laundry area were also observed to be locked and not accessible to clients. During the facility tour, LPA observed that restrooms located in Buildings B and C had water temperatures reading above 160°F, which exceeds the regulatory requirement of 105°F to 120°F.


(continued on 809C)

NAME OF LICENSING PROGRAM MANAGER: David Sicairos
NAME OF LICENSING PROGRAM ANALYST: Gabriela Castro
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 05/21/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/21/2026
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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Document Has Been Signed on 05/22/2026 07:05 AM - It Cannot Be Edited


Created By: Gabriela Castro On 05/21/2026 at 12:40 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: HAMILTON VILLA
FACILITY NUMBER: 198600271

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/21/2026

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
80088(e)(1)
Fixtures, Furniture, Equipment, and Supplies
(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
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Based on observation, hot water temperatures in Buildings B and C were measured at over 160 degrees Fahrenheit, which exceeds the regulatory requirement of 105 to 120 degrees Fahrenheit. Additionally, Building D did not have hot water available which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 05/22/2026
Plan of Correction
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Licensee shall ensure hot water temperatures throughout the facility are maintained between 105 and 120 degrees.. Licensee shall restore hot water access in Building D and ensure all buildings have functioning hot water available to clients at all times. Licensee shall submit a plan on how the facility will maintain water temp. within the required range and proof of correction to LPA by POC due date of 5/22/26, including temperature logs for all buildings for a minimum of seven (7) consecutive days and photos/documentation showing hot water has been restored in Building D, by 5/28/26.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
David Sicairos
NAME OF LICENSING PROGRAM MANAGER:
Gabriela Castro
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 05/21/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/21/2026


LIC809 (FAS) - (06/04)
Page: 3 of 6
Document Has Been Signed on 05/22/2026 07:05 AM - It Cannot Be Edited


Created By: Gabriela Castro On 05/21/2026 at 12:40 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: HAMILTON VILLA
FACILITY NUMBER: 198600271

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/21/2026

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
80087(a)
Building and Grounds
(a) The facility shall be clean, safe, sanitary and in good repair at all times for the safety and well-being of clients, employees and visitors.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation during the facility walkthrough, the facility was observed to have holes in walls, cracked tiles in restrooms, damaged doors, damaged shower handles, and areas throughout the facility that required painting. Additionally, a broken mirror was observed in the restroom located in Building D which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 06/22/2026
Plan of Correction
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Licensee shall repair all identified maintenance and safety concerns throughout the facility, including holes in walls, cracked restroom tiles, damaged doors, damaged shower handles,exposed wiring and the broken mirror located in Building D restroom. Licensee shall also repaint areas observed to be in need of painting to ensure the facility is maintained in a clean, safe, and sanitary condition. Licensee shall submit proof of correction to LPA by the POC due date, including photos and/or repair invoices documenting completed repairs.
Type B
Section Cited
HSC
1507(c)(1)(B)
General Provisions
(1) For regional center clients the following shall apply: (B) The client's individualized health care plan shall be reassessed at least every 12 months or more frequently as determined by the client's physician or nurse practitioner during the time the client receives incidental medical services in the facility.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation and record review, clients C3 and C7 did not have medical assessments on file.which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 06/15/2026
Plan of Correction
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Licensee shall submit copies of the completed medical assessments to LPA by the POC due date. Licensee shall also conduct an audit of all client files to ensure required medical assessments are maintained and current for all residents.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
David Sicairos
NAME OF LICENSING PROGRAM MANAGER:
Gabriela Castro
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 05/21/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/21/2026


LIC809 (FAS) - (06/04)
Page: 4 of 6
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: HAMILTON VILLA
FACILITY NUMBER: 198600271
VISIT DATE: 05/21/2026
NARRATIVE
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Building D did not have hot water available at the time of the visit. Building A had a water temperature reading of 109.2°F, which was within the regulatory requirement. Citations will be issued for the water temperatures observed in Buildings B and C, as well as for the lack of hot water in Building D. During the walk through of all four buildings, repairs were observed to be needed throughout the facility in client restrooms, bedrooms, and hallway areas. Exposed electrical wiring was also observed in hallway area.

Food Service

Refrigerators and freezers were maintained at proper temperatures, with refrigerators at a maximum of 40°F and freezers at 0°F. The facility maintained a sufficient supply of at least two (2) days of perishable food and seven (7) days of non-perishable food. Knives were observed to be secured in the kitchen area.

Health-Related Services & Records:
Seven (7) client files were reviewed and contained required documentation, including Admission Agreements, Pre-Placement Appraisals, Consents, Physician’s Reports with TB and ambulatory status, and Rights Acknowledgments. During file review, it was observed that clients C3 and C7 did not have TB documentation on file. Additionally, C3 and C7 did not have Physicians Reports on file. Seven (7) client medications were reviewed. Medications were properly labeled and stored in locked medication carts, which were secured in a locked closet located within the medication room. MAR logs were reviewed and observed to be updated accurately.

Disaster Preparedness:
Fire drill records were not available for review at the time of the visit. Emergency food and disaster supplies, including water, food, flashlights, batteries, and first aid supplies, were observed during the visit.

.Personnel Records & Training:
Four (4) staff files were reviewed and included criminal record clearances, CPR/First Aid and TB screenings. Administrator Certificate for Adela Santos was valid through July 14, 2026. Staffing ratio met requirements.


An exit interview was conducted with Adela Santos, Administrator During the inspection, deficiencies were observed and cited on the attached LIC 809D/809C in accordance with Title 22, Division 6 regulations. The Administrator agreed to submit proof of correction by the due dates specified. A copy of this report, LIC 809D/809C, and appeal rights will be provided via email.

NAME OF LICENSING PROGRAM MANAGER: David Sicairos
NAME OF LICENSING PROGRAM ANALYST: Gabriela Castro
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 05/21/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/21/2026
LIC809 (FAS) - (06/04)
Page: 5 of 6
Document Has Been Signed on 05/22/2026 07:05 AM - It Cannot Be Edited


Created By: Gabriela Castro On 05/21/2026 at 01:19 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: HAMILTON VILLA
FACILITY NUMBER: 198600271

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/21/2026

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
85068.4(g)
(g) If acceptance or retention of an individual 60 years of age or older would result in the number of persons 60 years of age or older exceeding 50 percent of the census in facilities with a capacity of six or fewer clients, or 25 percent of the census in facilities with a capacity over six, the licensee must request an exception in order to accept or retain the individual. The exception request must be made in accordance with Section 80024. The documentation specified in Section 85068.4(c) must be submitted with the exception request.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, the facility is licensed to serve clients ages 18 to 59. The facility’s current census is sixty (60) clients; however, twenty-five (25) clients residing at the facility are over the age of 59 which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 06/15/2026
Plan of Correction
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Based on the current census and allowable ratio, the facility may have up to twenty (20) clients over the age of 59. Licensee shall provide exception request(s) for the additional clients by the POC due date. Licensee shall also ensure the facility remains within the allowable ratio and that future admissions remain within the facility’s licensed age range unless prior exception has been granted by the Department.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
David Sicairos
NAME OF LICENSING PROGRAM MANAGER:
Gabriela Castro
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 05/21/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/21/2026


LIC809 (FAS) - (06/04)
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