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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198601302
Report Date: 12/01/2025
Date Signed: 12/01/2025 02:05:50 PM

Document Has Been Signed on 12/01/2025 02:05 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
CCLD Regional Office, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754
FACILITY NAME:C-H ADULT DAY CENTER PROGRAMFACILITY NUMBER:
198601302
ADMINISTRATOR/
DIRECTOR:		BROWN, MARIETTAFACILITY TYPE:
775
ADDRESS:8026 E ALONDRA BLVDTELEPHONE:
(562) 630-8123
CITY:PARAMOUNTSTATE: CAZIP CODE:
90723
CAPACITY: 70CENSUS: 27DATE:
12/01/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:03 AM
MET WITH:David Berry, Administrator TIME VISIT/
INSPECTION COMPLETED:
02:10 PM
NARRATIVE
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Licensing Program Analyst (LPA) Galarza conducted an unannounced Required- 1 year visit. The purpose of the visit was explained to new Administrator David Berry. The Day Program is licensed to serve 70 ambulatory, of which 12 may be non-ambulatory developmentally disabled adults ages 18 and over, vendored by South Central Los Angeles Regional Center. The facility provides transportation services, and is equipped with 20 vans. Clients bring their own meals and snacks. Facility provides Community Inclusion Services programming.

The following were observed/inspected:



Infection Control: An Infection Control Plan was submitted to CCL and was available on site for review.

Physical Plant/Environment Safety: Facility is a one story building. The program consists of a reception area, 2 activity rooms, 3 restrooms (1 men, 1 women, 1 shared), kitchen, staff kitchen, locker room, 3 storage rooms, 4 offices and 1 conference room. There is no outdoor patio area for activities.Exit doors are free of any obstruction and there are no pools or large bodies of water. Electrical smoke and sprinklers, and carbon monoxide detectors were observed. The facility has 12 fire extinguishers. Cleaning supplies and toxic substances are inaccessible to clients. The facility maintains emergency food supply and water. Emergency Phone numbers, exit plan and programming schedules were posted. The building contains central air conditioning and heating. First aid kits/Manuals are kept in activity rooms; consisting of thermometer, tweezers, scissors, antiseptic, bandages, gauze. The facility's last fire inspection was conducted on 6/24/2025.

*Water temperature readings did not measure within the required 105 - 120 degrees Fahrenheit. The fire exit door that leads to the street in activity room area B does not close properly, staff must pull it to close. Citations were issued.

NAME OF LICENSING PROGRAM MANAGER: Lisa Hicks
NAME OF LICENSING PROGRAM ANALYST: Noemi Galarza
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 12/01/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/01/2025
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
CCLD Regional Office, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754
FACILITY NAME: C-H ADULT DAY CENTER PROGRAM
FACILITY NUMBER: 198601302
VISIT DATE: 12/01/2025
NARRATIVE
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Operational Requirements: Fire clearance is approved for 58 ambulatory and 12 non-ambulatory clients. Care and supervision to meet the clients needs was observed. Special equipment i.e. wheelchairs are used. Liability insurance expires 1/6/2026. The facility handles client's monies and provides stipends to clients if needed.
Staffing: A total of 22 staff members provide care and supervision to the clients.

Personnel Records/Staff Training: Eight (8) staff files were reviewed for criminal background clearance and training. Personnel records have health/TB screenings, certifications, and 1st Aid/CPR training. Staff training is conducted monthly. Administrator on record passed away 8/26/2025. Licensee has not submitted change of Administrator documents.

Client Rights/Information: Personal rights were posted and in client files.

Client Records/Incident Reports: Eight (8) client files were reviewed. They contained ISP, IPP, medical assessments, and TB clearance. Client (C8) was missing a medical assessment. A citation was issued.

Food Service: There is a staff kitchen and a client kitchen. In the client kitchen cockroaches were observed. All sharps were locked. Clients bring their own lunch, but snacks and meals are provided if needed.

Health Related Services: Two clients require centrally stored medications. MAR records were reviewed.

Incident Medical and Dental: All clients have Individual Services Plans on file. Staff training was observed.

Disaster Preparedness, and Emergency Intervention: The facility has an updated Emergency Disaster Plan LIC 610D containing emergency evacuation information. An emergency drill was conducted on 10/30/2025, within the last 6 months as required. The facility conducts monthly emergency drills addressing different training topics.

Emergency Intervention: Staff are trained in CPI emergency intervention techniques.

Pursuant to Title 22 deficiencies were observed and cited.


Exit interview conducted with Administrator David Berry. A copy of the report and appeal rights was provided.
NAME OF LICENSING PROGRAM MANAGER: Lisa Hicks
NAME OF LICENSING PROGRAM ANALYST: Noemi Galarza
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 12/01/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/01/2025
LIC809 (FAS) - (06/04)
Page: 3 of 6
Document Has Been Signed on 12/01/2025 02:05 PM - It Cannot Be Edited


Created By: Noemi Galarza On 12/01/2025 at 01:08 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: C-H ADULT DAY CENTER PROGRAM
FACILITY NUMBER: 198601302

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/01/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
82088(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 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, the licensee did not comply with the section cited above in that two client restrooms had water temperature readings of 134.2 DF & 134 DF, which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 12/02/2025
Plan of Correction
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Administrator immediately called a plumber that came to the facility to adjust the hot water temperature in the bathrooms.
Submit a hot water temperature log showing the water was tested at least twice a day today and tomorrow.
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.
Lisa Hicks
NAME OF LICENSING PROGRAM MANAGER:
Noemi Galarza
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 12/01/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/01/2025


LIC809 (FAS) - (06/04)
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Document Has Been Signed on 12/01/2025 02:05 PM - It Cannot Be Edited


Created By: Noemi Galarza On 12/01/2025 at 01:08 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: C-H ADULT DAY CENTER PROGRAM
FACILITY NUMBER: 198601302

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/01/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
82087(a)
Buildings and Grounds
(a) The program site 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 in that 1. the fire exit door that leads to the street in activity room area B does not close properly and staff must pull it to close and 2. cockroaches were observed in the client kitchen counter, which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 12/29/2025
Plan of Correction
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Administrator agreed to submit proof that the door in activity room B was repaired. Please submit a video and photo that depicts the door is completely functional and submit proof that the kitchen received pest control services.
Type B
Section Cited
CCR
82070(b)(8)
Client Records.
Each record must contain information including, but not limited to, the following: (8) Medical assessment, including ambulatory status, as specified in Section 82069(b).
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 in that client (C8's) last Physician's Report on file is dated 1/30/15, which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 12/29/2025
Plan of Correction
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Administrator agreed to submit a current copy of C8's Physician's Report.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Lisa Hicks
NAME OF LICENSING PROGRAM MANAGER:
Noemi Galarza
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 12/01/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/01/2025


LIC809 (FAS) - (06/04)
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Document Has Been Signed on 12/01/2025 02:05 PM - It Cannot Be Edited


Created By: Noemi Galarza On 12/01/2025 at 01:48 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: C-H ADULT DAY CENTER PROGRAM
FACILITY NUMBER: 198601302

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/01/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
82064(i)
Administrator - Qualifications and Duties. When the administrator is absent from the day program for more than 30 consecutive days, the licensee shall designate a substitute who meets the qualifications of an administrator as specified in Sections 82064(a), (b) and (c). 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 in that Administrator on record passed away on 8/26/2025 and Licensee did not notify CCL or new Administrator appointment, which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 12/12/2025
Plan of Correction
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Licensee shall submit change of Administrator documents to LPA. LPA emailed a list of documents required.
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.
Lisa Hicks
NAME OF LICENSING PROGRAM MANAGER:
Noemi Galarza
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 12/01/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/01/2025


LIC809 (FAS) - (06/04)
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