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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198600484
Report Date: 03/17/2025
Date Signed: 03/18/2025 08:31:23 AM

Document Has Been Signed on 03/18/2025 08:31 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:MANAGUA CAREFACILITY NUMBER:
198600484
ADMINISTRATOR/
DIRECTOR:		HELLER, ESTERA L.FACILITY TYPE:
735
ADDRESS:2515 MOUNTAIN BROOK DRIVETELEPHONE:
(626) 333-0402
CITY:HACIENDA HEIGHTSSTATE: CAZIP CODE:
91745
CAPACITY: 5CENSUS: 5DATE:
03/17/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:00 AM
MET WITH:Estera Heller, AdministratorTIME VISIT/
INSPECTION COMPLETED:
11:39 AM
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Licensing Program Analyst (LPA) Sanjay Vaid conducted an unannounced Annual/Required visit. The purpose of today’s visit was discussed with DSP Staff Lindokuhle Bhembe who allowed entry. Administrator Estera Heller arrived shortly and accompanied LPA on a tour of the facility. There are currently five (5) ambulatory San Gabriel Valley/Pomona Regional Center clients in the home. Facility fees are due, pin and amount provided to Administrator. Confirmation of facility fees paid was provided to LPA Vaid.

A physical plant inspection of the interior and exterior areas was completed. Facility grounds are free from debris and potential hazards. The facility consists of four (4) client bedrooms, two (2) client bathrooms, living room, family room, laundry room, and kitchen with dining area. Backyard and patio area have a shaded patio furniture and there is an attached garage. Last facility fire drill was on 01/13/25 earthquake drill, 01/20/25 fire drill. A carbon monoxide detector and interconnected smoke detectors were tested and are operational. Facility has fire pull alarm system and one (1) fire extinguisher. Fire extinguisher last serviced on 10/23/24. Toxins and sharps are inaccessible to clients. Facility maintained a comfortable temperature during the time of visit. Hot water temperature was measured in two (2) bathrooms and kitchen with a reading of 112.7 Degrees Fahrenheit. There are lights for each room to ensure safety and comfort for all residents in the facility. Centrally stored medicines are locked and inaccessible. There is a minimum of seven (7) days of nonperishable and two (2) days of perishable food in the home.

LPA reviewed three(3) staff records. Staff are associated with the license, have a criminal record clearance, a negative test results for tuberculosis, physician’s report, and First Aid/CPR training, employee rights, and personnel record. Mandated required postings were observed in the hallway. LPA reviewed five (5) client records.

Continued on 809C......
SUPERVISORS NAME: Fernando Fierros
LICENSING EVALUATOR NAME: Sanjay Vaid
LICENSING EVALUATOR SIGNATURE: DATE: 03/17/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/17/2025
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 2
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: MANAGUA CARE
FACILITY NUMBER: 198600484
VISIT DATE: 03/17/2025
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All clients have documentation of a medical assessment, admission agreement, ID/emergency information, negative test result for tuberculosis, medical consent forms, resident appraisal, Individual Program Plan (IPP), personal rights, and centrally stored medication records in their files. Administrator certificate expires 11/01/2025.

No health and safety concerns or deficiencies were observed at this time. An exit interview was conducted and a copy of the report was given and reviewed with Administrator Estera Heller.
SUPERVISORS NAME: Fernando Fierros
LICENSING EVALUATOR NAME: Sanjay Vaid
LICENSING EVALUATOR SIGNATURE:

DATE: 03/17/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/17/2025
LIC809 (FAS) - (06/04)
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