198602094-5-19-2026-28-AS-NGAA-DU8TYB-20260519150828

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 198602094
Report Date: 05/19/2026
Date Signed: 05/19/2026 03:08:33 PM

Document Has Been Signed on 05/19/2026 03:08 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:	VILLA ESPERANZA SERVICES (DIMENSIONS)		FACILITY NUMBER:	198602094
ADMINISTRATOR/ DIRECTOR:	CLAUDIA CORTEZ		FACILITY TYPE:	775
ADDRESS:	1990 EAST WALNUT STREET		TELEPHONE:	(626) 449-2919
CITY:	PASADENA	STATE: CA	ZIP CODE:	91107
CAPACITY: 65		CENSUS: 52	DATE:	05/19/2026
TYPE OF VISIT:	Case Management - Incident	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	12:55 PM
MET WITH:	Damion Jackson, Associate Program Administrator		TIME VISIT/ INSPECTION COMPLETED:	03:10 PM

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Licensing Program Analyst (LPA) Galarza conducted a Case Management- Incident visit to follow up on a 3rd party SOC 341 Report of Suspected Dependent Elder Abuse incident report dated 5/15/2026. LPA met with Associate Program Administrator Damion Jackson and Manager Claudia Cortez and explained the purpose of the visit.

According to SOC 341, on May 14, 2026 at approximately 10:10 AM, client (C1) was allegedly rough handled and hit by staff (S1)/skills instructor. The report alleges S1 hit C1 on their head with a chair.

Staff interviews were conducted. Client (C1) did not attend day program today and was not interviewed. A client witness was interviewed. C1's records were reviewed. The client has history of story fabrication and behaviors, but is receptive to verbal redirection.

The findings indicate that C1 was in room #6 setting up a movie projector and was experiencing difficulty setting it up. Staff (S1) gave verbal directions in a loud and firm tone at least 4 times on how to set up the projector. As a result, C1 got overwhelmed and squatted down on the floor and began to cry. S1 walked over to the left of C1 and allegedly lightly pushed C1 with their hip resulting in the client falling over and hitting their head on the table. According to information obtained S1 has a loud tone firm voice.

Based on record review, on May 14, 2026 the facility self-reported/faxed the incident via SOC 341 to CCL and 3rd party agencies.

Staff (S1) is currently suspended pending incident investigation. Facility Administration plans to provide staff an in-service training, and determine the course of action pertaining to S1's conduct.

An exit interview was conducted with Damion Jackson. A copy of the report was provided.

NAME OF LICENSING PROGRAM MANAGER: Lisa Hicks
NAME OF LICENSING PROGRAM ANALYST: Noemi Galarza
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 05/19/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/19/2026

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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