198601842-3-2-2026-28-AS-JBAE-DRSR2D-20260302113810

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 198601842
Report Date: 03/02/2026
Date Signed: 03/02/2026 11:38:31 AM

Document Has Been Signed on 03/02/2026 11:38 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:	SHERYL FACILITY		FACILITY NUMBER:	198601842
ADMINISTRATOR/ DIRECTOR:	DAMIEKA LASLEY		FACILITY TYPE:	735
ADDRESS:	19514 SHERYL AVE		TELEPHONE:	(562) 964-4782
CITY:	CERRITOS	STATE: CA	ZIP CODE:	90703
CAPACITY: 3		CENSUS: 3	DATE:	03/02/2026
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	08:10 AM
MET WITH:	Administrator Damieka Lasley		TIME VISIT/ INSPECTION COMPLETED:	11:52 AM

NARRATIVE

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On 3/02/2026 at 08:10 a.m., Licensing Program Analyst(s) (LPA) Jewel Baptiste conducted an unannounced annual visit at Sheryl Facility, using the CARE tool. LPA Baptiste met with House Lead Dorothy Brown and explained the reason for the visit. Administrator Damieka Lasley arrived at 8:30 a.m. and assisted with the visit.

The facility is licensed to serve clients ages 18-59. Fire clearance was approved for two (2) non-ambulatory and one (1) ambulatory. The facility is a single-story home, located in a residential area. It consists of 3 client bedrooms (1 with a private bathroom), 1 bathroom, 1 sitting area, 1 dining room, 1 living room with a covered fireplace/office, 1 laundry closet, a kitchen, a garage, a front yard, and a backyard.

LPA Baptiste conducted a tour of the facility with the House Lead and observed the following: The facility is clean and in good repair indoors and outdoors. The fire extinguisher observed in the kitchen and hallway was charged and updated. The cleaning supplies and sharps were locked under the kitchen sink. Sufficient food supplies were observed, at least 2 days of perishables and 7 days of non-perishables. The refrigerator drawer was observed to be broken. The three (3) bedrooms were observed with sufficient lighting, furniture, and bedding supplies. One (1) client dresser was in disrepair. (2) Client’s bathrooms were observed in working conditions with grab bars and skid mats. The water temperature was tested at 105.4 – 105.6 degrees F., which is within the required 105-120 degrees F. The dining room and living room were observed with sufficient sitting areas. Smoke/Carbon monoxide detectors were tested and are in working condition. The garage contained storage supplies, PPE, water, toiletries, and extra food. The backyard was observed with a covered sitting area. (CONTINUED LIC 809C)

NAME OF LICENSING PROGRAM MANAGER: Lisa Hicks
NAME OF LICENSING PROGRAM ANALYST: Jewel Baptiste
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 03/02/2026

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/02/2026

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: SHERYL FACILITY	FACILITY NUMBER: 198601842
	VISIT DATE: 03/02/2026

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The facility does not have any large body of water. The last emergency drill was conducted on 2/12/26. LPA Baptiste reviewed medication and files for 3 clients. Each client file reviewed has all the required documentation. The physician's report for the clients was dated 2/25/2025. The Administrator showed proof that a doctor's appointment was scheduled for 2/17/2026 and was canceled by the provider. The Administrator provided the follow-up appointment dated 4/17/2026. The Administrator will send the new physician's report on 4/18/2026 to LPA. Staff files were reviewed for (3) staff, and they all have the required documentation. An administrator certificate was reviewed for Damieka Lasley exp: 1/22/27.

Per California Code of Regulations, Title 22, and California Health and Safety, the following deficiencies were cited (refer to LIC 809-D). An exit interview was held, and a copy of the report was provided to the Administrator.

NAME OF LICENSING PROGRAM MANAGER: Lisa Hicks
NAME OF LICENSING PROGRAM ANALYST: Jewel Baptiste
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 03/02/2026

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/02/2026

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 03/02/2026 11:38 AM - It Cannot Be Edited

Created By: Jewel Baptiste On 03/02/2026 at 11:15 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: SHERYL FACILITY	FACILITY NUMBER: 198601842
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 03/02/2026

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
1 2 3 4	Based on observation, the licensee did not comply with the section cited above in 2 items in the home was in disrepair, which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 03/18/2026
	Plan of Correction
1 2 3 4	Photo proof of bathrooms, new dresser in client #1 room, and refrigerator drawer is needed by POC due date.

Section Cited


	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

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:

	Jewel Baptiste
NAME OF LICENSING PROGRAM ANALYST:

LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 03/02/2026

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/02/2026

LIC809 (FAS) - (06/04)

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