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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198600775
Report Date: 09/09/2025
Date Signed: 09/09/2025 04:25:28 PM

Document Has Been Signed on 09/09/2025 04:25 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:STRATA BELLA (NORWALK) CORPORATIONFACILITY NUMBER:
198600775
ADMINISTRATOR/
DIRECTOR:		RUDY DEOCAMPOFACILITY TYPE:
735
ADDRESS:13213 FLALLON AVENUETELEPHONE:
(562) 864-9803
CITY:NORWALKSTATE: CAZIP CODE:
90650
CAPACITY: 4CENSUS: 4DATE:
09/09/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:29 AM
MET WITH:Florinda Aleman, Direct Support PersonnelTIME VISIT/
INSPECTION COMPLETED:
04:30 PM
NARRATIVE
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Licensing Program Analyst (LPA) Mayra Cota conducted an unannounced required annual visit. LPA met with Florinda Aleman, Direct Support Personnel and explained the reason for the visit. Jon De La Cruz, Administrator, arrived thereafter and assisted with the visit.

The facility is licensed to serve (4) developmentally disabled adults ages 18 to 59 years of age; three (3) can be non-ambulatory. Clients receive services through the Harbor Regional Center. The facility is in a residential area of Norwalk, CA.

During the visit, LPA toured the facility's indoor and outdoor environment, reviewed 4 client and 3 staff records and conducted medication review for (4) clients. The facility is a single-story house which consists of: receiving room, living room, kitchen, dining area, laundry area, 4 client bedrooms, 1 staff room, 2 bathrooms, attached garage and front and backyard.

During today’s visit, LPA observed the following:

The facility is free of debris, hazards and walkways, passageways and exits are free of obstruction. Living room was observed clean, however, two reclining chairs have torn armrests which are covered with duct tape. Kitchen appliances are clean and were operating at the time of visit. Sufficient supply of 2 day perishable and 7 day non-perishable food was observed. Food is labeled and kept within expiration limits. Facility has an emergency supply of food and water, and additional emergency supplies like flashlights and batteries in living the room closet. Cleaning supplies and toxins were observed in a cabinet under kitchen sink; however, the latch holding the doors together did not secure door appropriately and latch falls off at minimal contact.
***Continues on LIC 809-C
NAME OF LICENSING PROGRAM MANAGER: Wei Siew Ho
NAME OF LICENSING PROGRAM ANALYST: Mayra Cota
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 09/09/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/09/2025
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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Document Has Been Signed on 09/09/2025 04:25 PM - It Cannot Be Edited


Created By: Mayra Cota On 09/09/2025 at 11:49 AM
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: STRATA BELLA (NORWALK) CORPORATION
FACILITY NUMBER: 198600775

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/09/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
80087(g)
Building and Grounds
(g) Disinfectants, cleaning solutions, poisons, firearms and other items that could pose a danger if readily available to clients shall be stored where inaccessible to clients.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, the licensee did not comply with the section cited above due to the following: cleaning supplies, toxins, knives and other sharps were observed not locked properly and accessible to clients, which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 09/10/2025
Plan of Correction
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Secure locks on both the knife drawer in the kitchen and cleaning supply cabinet under kitchen sink have to be installed by POC due date.
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.
Wei Siew Ho
NAME OF LICENSING PROGRAM MANAGER:
Mayra Cota
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 09/09/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/09/2025


LIC809 (FAS) - (06/04)
Page: 3 of 7
Document Has Been Signed on 09/09/2025 04:25 PM - It Cannot Be Edited


Created By: Mayra Cota On 09/09/2025 at 11:49 AM
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: STRATA BELLA (NORWALK) CORPORATION
FACILITY NUMBER: 198600775

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/09/2025

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, the licensee did not comply with the section cited above due to two (2) reclining chairs having torn armrests which are covered with duct tape, which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 09/30/2025
Plan of Correction
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Licensee will replace damaged reclining chairs and provide LPA with purchase receipts and photos of the newly purchased chairs in the living room of the home by POC due date.
Type B
Section Cited
CCR
85087.2(b)
Outdoor Activity Space
(b) The outdoor activity area shall provide a shaded area, and shall be comfortable, and furnished for outdoor use.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, the licensee did not comply with the section cited above due to not having a furnished shaded area for clients, which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 09/30/2025
Plan of Correction
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Licensee will obtain a table and sufficient chairs with a patio umbrella and provide LPA recepits of purchase and photos of the items placed in the backyard of the facility by POC due date.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Wei Siew Ho
NAME OF LICENSING PROGRAM MANAGER:
Mayra Cota
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 09/09/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/09/2025


LIC809 (FAS) - (06/04)
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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: STRATA BELLA (NORWALK) CORPORATION
FACILITY NUMBER: 198600775
VISIT DATE: 09/09/2025
NARRATIVE
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Also, knives and other sharps were observed accessible to clients due to lock on the kitchen drawer, missing the handle in which a padlock present at the time of inspection could not secure the drawer to stay locked. Client bedrooms have the required furniture such as bed frames, dressers, lamps, and chairs. Bedrooms also have sufficient closet space. Client beds have the required linen and mattress pads. There is a closet in the hallway with extra clean linen, towels, and personal hygiene items for clients. Two full bathrooms were inspected and were observed clean. The water temperature was tested in both bathrooms and measured 110.1 degrees F in bathroom 1 and 105.4 degrees F in bathroom 2 which is within the required 105 - 120 degrees F. Laundry area was observed locked. Detergents are kept locked and inaccessible to clients. Washer and dryer were observed in good repair and working during visit. LPA requested access to a door located by the bedroom hallway; however, staff informed LPA that the door cannot be opened due to having a renter on sight in the sectioned-off garage room behind the door. The front of the garage was inspected and found to be inaccessible to from the inside of the house. Administrator indicated at the time of visit, renter has been living in the sectioned-off room in the garage for several months, but could not provide LPA with information as to when the room was built, if there are building permits in place for this additional room or if Licensee notified CCLD about the alteration to the garage. Administrator could not provide proof of criminal background clearance for the renter/tenant at the time of visit. According to Administrator, the last fire inspection was conducted in 2014; however no documentation was provided at the time of visit. The front and backyard are well maintained and there are no pools or large bodies of water. Facility does not have a furnished, shaded area for clients in care. One (1) fire extinguisher was observed charged and last inspected on 4/10/25. Last fire/safety drill was conducted on 7/4/25.

Per California Code of Regulations, Title 22, and California Health and Safety Code, deficiencies are cited and Civil Penalties assessed today. Exit interview conducted with Mercedes Bedolla, Direct Support Personnel and a copy of the report was provided. Administrator was informed telephonically due to having to leave before exit interview.
NAME OF LICENSING PROGRAM MANAGER: Wei Siew Ho
NAME OF LICENSING PROGRAM ANALYST: Mayra Cota
LICENSING PROGRAM ANALYST SIGNATURE:

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

DATE: 09/09/2025
LIC809 (FAS) - (06/04)
Page: 5 of 7
Document Has Been Signed on 09/09/2025 04:25 PM - It Cannot Be Edited


Created By: Mayra Cota On 09/09/2025 at 02:12 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: STRATA BELLA (NORWALK) CORPORATION
FACILITY NUMBER: 198600775

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/09/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
80010(a)

80010(a) Limitations on Capacity and Ambulatory Status
(a) A licensee shall not operate a facility beyond the conditions and limitations specified on the license, including the capacity limitation.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation and record review, facility is licensed as an ARF. Capacity is 4; however, there is a renter on site , an additional bedroom in the sectioned off garage which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 09/10/2025
Plan of Correction
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Administrator/Licensee will provide a statement in which the following will be indicated: a plan showing how the staff will maintain capacity as an ARF only. The statement must aknowledge the intent of the regulations to mainitain compliance.
Type A
Section Cited
CCR
80020(a)

80020(a) Fire Clearance (a) All facilities shall secure and maintain a fire clearance approved by the city or county fire department, the district providing fire protection services, or the State Fire Marshal.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation and record review, the licensee did not comply with the section cited above due to facility not having an approved fire clearance for the alteration to the garage which is sectioned-off and converted into a room which is rented out currently, which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 09/10/2025
Plan of Correction
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Administrator/Licensee will inform of the plan to clear the deficiency by POC due date.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Wei Siew Ho
NAME OF LICENSING PROGRAM MANAGER:
Mayra Cota
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 09/09/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/09/2025


LIC809 (FAS) - (06/04)
Page: 6 of 7
Document Has Been Signed on 09/09/2025 04:25 PM - It Cannot Be Edited


Created By: Mayra Cota On 09/09/2025 at 02:21 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: STRATA BELLA (NORWALK) CORPORATION
FACILITY NUMBER: 198600775

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/09/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
80019(e)(2)
80019(e)(2) Criminal Record Clearance (e) All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1522 shall prior to working, residing or volunteering in a licensed facility: (2) Obtain a California clearance or a criminal record exemption as required by the Department

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, the licensee did not comply with the section cited above due to staff not being able to provide proof of criminal background clearance for renter/tenant, which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 09/10/2025
Plan of Correction
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Administrator/Licensee will inform of the plan to clear the deficiency by POC due date.
Type A
Section Cited
CCR
80044(a)(2)
80044 Inspection Authority of the Licensing Agency(a) The licensing agency shall have the inspection authority specified in Health and Safety Code Sections 1526.5, 1533, 1534, 1538, and 1538.7. (2) Health and Safety Code Section 1533 provides in part:...any duly authorized officer, employee, or agent of the State Department of Social Services may, upon presentation of proper identification, enter and inspect any place providing personal care, supervision, and services at any time, with or without advance notice, to secure compliance with, or to prevent a violation of, any provision of this chapter.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation the licensee did not comply with the section cited above due to staff not granting access to a door inside the home which leads into the sectioned-off room in which a renter/tenant resides, which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 09/10/2025
Plan of Correction
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Access to the room is needed; therfore, Administrator/Licensee will grant access to the sectioned-off room behind the garage by POC due date.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Wei Siew Ho
NAME OF LICENSING PROGRAM MANAGER:
Mayra Cota
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 09/09/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/09/2025


LIC809 (FAS) - (06/04)
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