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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198601587
Report Date: 11/04/2025
Date Signed: 11/04/2025 04:34:34 PM

Document Has Been Signed on 11/04/2025 04:34 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:CHOICES R US - ZAMORAFACILITY NUMBER:
198601587
ADMINISTRATOR/
DIRECTOR:		LASHON JOHNSONFACILITY TYPE:
735
ADDRESS:10524 E ZAMORA AVETELEPHONE:
(562) 445-3009
CITY:LOS ANGELESSTATE: CAZIP CODE:
90002
CAPACITY: 4CENSUS: 4DATE:
11/04/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:43 AM
MET WITH:Lashon JohnsonTIME VISIT/
INSPECTION COMPLETED:
04:35 PM
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Licensing Program Analyst (LPA) Sakinah Madyun conducted the annual inspection using the Compliance and Regulatory Enforcement (CARE) tools. LPA Madyun was met by Direct Support Staff Unique Johnson at approximately 8:45 AM and explained reason for visit. Administrator Lashon Johnson was notified via cell phone and arrived shortly thereafter. The facility is licensed for a capacity of four (4) developmentally disabled clients between the ages of 18-59, four (4) of which may be non-ambulatory. The facility is vendored through the South-Central Los Angeles Regional Center.

The facility is a single-story home located in a residential neighborhood. It consists of four (4) individual client bedrooms, a living room, dining room, a kitchen, two (2) shared client bathrooms, a front and back patio area, a laundry room, and a detached garage that stores additional chemicals and cleaning supplies.LPA toured the facility and observed the following:

Physical Plant & Environmental: Each client bedroom has the required furniture and bedding. There is extra clean linen and towels in hallway cabinet. Smoke detectors and carbon monoxide detectors were observed in each room and throughout the facility and are properly operating. The facility has one (1) fully charged fire extinguisher which is located in the kitchen. Cleaning supplies and toxic substances are inaccessible to clients and securely locked and stored in garage as well as the other locked cupboard in laundry room. The freezer is maintained at a temperature of 0-degree Fahrenheit and the refrigerator at a maximum of 45 degrees Fahrenheit. LPA observed a sufficient supply of 2 days perishable & 7 days non-perishable foods in the kitchen. There are no firearms or weapons stored at the facility. The hot water temperature in the bathrooms and kitchen measured between the required range of 105-120 degrees Fahrenheit. There is a shaded seating area for the residents located in the backyard. The facility does not have a swimming pool or bodies of water on the premises. The passageways and exits are free of obstruction. Continued LIC 809C

NAME OF LICENSING PROGRAM MANAGER: Lisa Hicks
NAME OF LICENSING PROGRAM ANALYST: Sakinah Madyun
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 11/04/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/04/2025
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
MONTEREY PARK ASC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754
FACILITY NAME: CHOICES R US - ZAMORA
FACILITY NUMBER: 198601587
VISIT DATE: 11/04/2025
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LPA observed Emergency Fire and Earthquake Drills Log recorded drills were conducted monthly and now quarterly with the last drill conducted 05/03/25.

Staff Personnel Files: LPA reviewed eleven (11) of eleven (11) staff files and will return for continuation visit at a later date and time to conduct staff interviews and review training logs.

Client Files: LPA reviewed four (4) of four (4) client files and will return for continuation visit at a later date and time to review medication logs and interview clients.

Infection Control Plan: First-aid kit was fully stocked and centrally stored locked in hallway medicine cabinet. LPA observed the Infection Control Plan revised 11/01/25 and Emergency Disaster Plan revised 11/01/25.

Due to time constraint LPA will return at a later date and time for a continuation visit. Exit interview was conducted with Administrator Lashon Johnson and a copy of this report was provided.

NAME OF LICENSING PROGRAM MANAGER: Lisa Hicks
NAME OF LICENSING PROGRAM ANALYST: Sakinah Madyun
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 11/04/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/04/2025
LIC809 (FAS) - (06/04)
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