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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198601402
Report Date: 02/21/2025
Date Signed: 02/24/2025 08:20:06 AM

Document Has Been Signed on 02/24/2025 08:20 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
CCLD Regional Office, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754
FACILITY NAME:DE LEON HOMEFACILITY NUMBER:
198601402
ADMINISTRATOR/
DIRECTOR:		MAUREEN DELEONFACILITY TYPE:
735
ADDRESS:11503 FERINA STTELEPHONE:
(562) 900-2717
CITY:NORWALKSTATE: CAZIP CODE:
90650
CAPACITY: 4CENSUS: 3DATE:
02/21/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:30 PM
MET WITH:Peggy DeLeonTIME VISIT/
INSPECTION COMPLETED:
04:51 PM
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Licensing Program Analyst (LPA) Nicol Wesley conducted an unannounced visit to conduct a required 1 year visit. LPA Wesley met with Peggy DeLeon and explained the purpose for the visit.

The facility is licensed to serve (4) developmentally disabled adults ages 18-59 years old, all non-ambulatory. Facility is operating within the approved capacity. Currently, there are four (4) clients in placement, there are no clients who have a restricted health care condition. All clients residing at this facility receive case management services provided by Harbor Regional Center.

LPA Wesley conducted a complete tour of the facility and utilized the Compliance and Regulatory Enforcement (CARE) tools for the todays visit. LPA observed the supply of food, Resident medications, and medication logs were reviewed. The smoke detectors/carbon monoxide detector are operable. LPA Wesley observed the fire extinguisher in the kitchen area to be fully charged and serviced. The water temperature was tested and measured degrees 105.2 F. The Last fire drill was conducted on 01/08/25. LPA Wesley attempted interviewed 4 residents and 3 staff. The smoke detectors/carbon monoxide detector are operable. The Liability insurance is current expires on 08/16/25. The Administrators certificate for Peggy DeLeon Certificate 7005947735 expires 12/12/25.

There are no deficiencies cited according to the California Code of Regulations, Title 22.

Exit interview conducted, and a copy of the report was given
SUPERVISORS NAME: Lisa Hicks
LICENSING EVALUATOR NAME: Nicol Wesley
LICENSING EVALUATOR SIGNATURE: DATE: 02/21/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/21/2025
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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