198601940-7-15-2025-28-AS-KRAZ-DJLTTU-20250715150118

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 198601940
Report Date: 07/15/2025
Date Signed: 07/15/2025 03:01:58 PM

Document Has Been Signed on 07/15/2025 03:01 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:	VILLA FLORA		FACILITY NUMBER:	198601940
ADMINISTRATOR/ DIRECTOR:	ROSALINDA BUENVIAJE		FACILITY TYPE:	735
ADDRESS:	10932 CARMENITA RD.		TELEPHONE:	(562) 941-5249
CITY:	WHITTIER	STATE: CA	ZIP CODE:	90605
CAPACITY: 34		CENSUS: 27	DATE:	07/15/2025
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	12:08 PM
MET WITH:	Administrator Joel Alonzo		TIME VISIT/ INSPECTION COMPLETED:	04:15 PM

NARRATIVE

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Licensing Program Analyst (LPA) Kimberly Ramirez conducted an unannounced Annual Required Visit on 07/15/2025. LPA Ramirez was met by Administrator Joel Alonzo and explained the purpose of the visit. The facility is licensed serve thirty-four (34) mentally disabled clients 18-59 years old, of which all must be ambulatory. There are 4 Units which are the client living quarters. Each unit has 2 stories. On the first floor of each unit, there is a living and dining area, kitchen, a bathroom which is shared by the clients and 2 bedrooms. The clients do not cook in the kitchens. Each bedroom has 2 beds. Upstairs, in each unit, there are 2 bedrooms, a bathroom which is shared by the clients, and a storage closet.

LPA utilized the Compliance and Regulatory Enforcement (CARE) tools for the visit today and observed the following:

Infection Control- Staff are using appropriate hand hygiene and wearing gloves while assisting clients. Facility has an Infection Control Plan in place.

Physical Plant & Environmental Safety- Disinfectants, cleaning solutions, poisons and other items that could pose a danger if readily available to residents, were observed to be inaccessible to clients. LPA Ramirez observed carbon monoxide detectors and smoke alarms in hallways. LPA Ramirez inspected four (4) shared client rooms. All the clients’ bedrooms contained the required furniture, linens and lighting. Water temperatures in all grooming and bathing areas were measured to be with 105 – 120 degrees. LPA Ramirez observed walls in client room#303 located in building 3 to be unsanitary with yellow/brownish stains and grime. LPA Ramirez observed all doors to buildings 1,3,4 to be wide open and observed more than 4 flies in buildings 1,3,4. LPA Ramirez will issue two (2) deficiencies based on these observations.

SEE 809-C

NAME OF LICENSING PROGRAM MANAGER: Fernando Fierros
NAME OF LICENSING PROGRAM ANALYST: Kimberly Ramirez
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 07/15/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/15/2025

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 07/15/2025 03:01 PM - It Cannot Be Edited

Created By: Kimberly Ramirez On 07/15/2025 at 02:01 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: VILLA FLORA	FACILITY NUMBER: 198601940
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 07/15/2025

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
1 2 3 4	Based on observation, LPA observed walls in client room#303 located in building 3 to be unsantiary with yellow/brownish stains and grime, the licensee did not comply with the section cited above in 1 bedroom which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 08/05/2025
	Plan of Correction
1 2 3 4	Licensee will clean and disinfect walls in room#303. LPA Ramirez will return to inspect room#303.

Type B

Section Cited

CCR

80087(a)(1)

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. (1) The licensee shall take measures to keep the facility free of flies and other insects. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation, LPA Ramirez observed all doors to buildings 1,3,4 to be wide open and observed more than 4 flies in buildings 1,3,4, the licensee did not comply with the section cited above in building 1,3,and 4, which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 07/22/2025
	Plan of Correction
1 2 3 4	Licensee will draft plan to address what measures staff are taking to ensure the facility will be free from flies.

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

	Fernando Fierros
NAME OF LICENSING PROGRAM MANAGER:

	Kimberly Ramirez
NAME OF LICENSING PROGRAM ANALYST:

LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 07/15/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/15/2025

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: VILLA FLORA	FACILITY NUMBER: 198601940
	VISIT DATE: 07/15/2025

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Operational Requirements- The fire clearance is approved for thirty-four (34) ambulatory clients aged 18-59 years. Staff provides care and needs according to the clients’ needs. Outdoor space with plenty of shade was observed.
Staffing- Administrator Certificate for Joel Alonzo was received by Administrator Certification Bureau (ACB) and is pending approval. Alternative Administrator Brian Buenviaje certificate expires 10/03/025. Staff employed are over the age of 18 and are fingerprint cleared and associated to the facility. One (1) member of staff is on duty from at least 10pm to 6:30 am to provide nighttime supervision.

Personnel Records-Training- Staff files are maintained at the facility. LPA Ramirez observed training, CPR and First Aid for three (3) out of the three (3) personnel records reviewed. LPA Ramirez observed TB testing results, Health screening, fingerprint clearance and job application for three (3) out of the three (3) personnel record reviewed. The administrator’s training on HIV and TB was reviewed and completed.

Clients Rights-Information- The facility has internet services and can provide internet access on a phone for clients to use.

Food Service- LPA Ramirez observed a sufficient supply of nonperishables for one week and perishable foods for a minimum of two days in the facility kitchen area. Soaps, detergents, and cleaning compounds were observed to be stored away from food supplies. Freezers and refrigerators were observed to be clean and within temperatures of 0-degree F (-17.7 degree C), and refrigerators with maximum temperature of 40-degree F. (4 degree C).

Client Records-Incident Reports- LPA Ramirez observed original admissions agreements in client records. LPA Ramirez observed Needs and Services and Functional Capabilities Assessment. LPA Ramirez observed current medication record orders and incident reports regarding clients’ health and safety.

Health Related Services- The medications are centrally stored in building#4 staff office and in bubble packs and/or in original containers. The facility provides incidental medical services.

Incidental Medical Services- There are zero (0) clients currently with Restricted Health conditions residing at the facility.

Disaster Preparedness- The facility has the Emergency Disaster Plan (LIC610D/9 pages) in place. Last documented emergency drills were conducted on 06/01/2025. LPA Ramirez observed facility sketches with exits and emergency exits routes throughout various locations of the facility. Emergency Intervention- Per Administrator Alonzo, the facility does not use manual restraints or seclusion rooms. Staff will use redirection when clients become agitated and contact the client’s doctor for further instructions.

Two (2) deficiencies were identified and cited during this annual inspection. One (1) civil penalty in the amount of $250 was issued for repeat violation. Exit interview was conducted and a copy of this report, 809-D, LIC421FC and appeals rights was provided via email.

NAME OF LICENSING PROGRAM MANAGER: Fernando Fierros
NAME OF LICENSING PROGRAM ANALYST: Kimberly Ramirez
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 07/15/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/15/2025

LIC809 (FAS) - (06/04)

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