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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198602123
Report Date: 07/16/2026
Date Signed: 07/16/2026 06:09:00 PM

Document Has Been Signed on 07/16/2026 06:09 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:PEOPLE'S CARE CAMERONFACILITY NUMBER:
198602123
ADMINISTRATOR/
DIRECTOR:		MARGIE KIMBLEFACILITY TYPE:
735
ADDRESS:2441 CAMERON AVETELEPHONE:
(626) 732-3500
CITY:COVINASTATE: CAZIP CODE:
91724
CAPACITY: 4CENSUS: 3DATE:
07/16/2026
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
04:30 PM
MET WITH:Filimon Gebremichael, AdministratorTIME VISIT/
INSPECTION COMPLETED:
06:00 PM
NARRATIVE
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Licensing Program Analyst (LPA) conducted a Case Management visit regarding concerns identified during a complaint investigation involving the handling of client Personal and Incidental (P&I) funds.

During the investigation, LPA identified deficiencies related to the handling, authorization, and documentation of client P&I funds. The investigation revealed that Client 1’s (C1) P&I account was $14.00 short for a reported cigarette purchase. No receipt was available, and the transaction was not properly documented on C1’s P&I ledger. The investigation also revealed that on 12/24/2025, Staff 1 (S1) purchased items for Client 1 (C1), Client 2 (C2), and Client 3 (C3). S1 later requested reimbursement of $18.00 from each client’s P&I funds. C3 was not present during the shopping outing. Client interviews revealed that the clients were not fully informed of the deductions before the money was taken from their P&I accounts. Review of records also showed that the transactions were not properly documented on the clients’ P&I ledgers, and receipts were not provided to the clients. Staff 2 (S2) stated that while preparing P&I funds for a subsequent outing, S2 observed a “cash out” entry on the clients’ ledgers. When S2 asked the clients about the withdrawal, the clients stated they were unaware that $18.00 had been taken from their accounts. The Administrator acknowledged the improper handling of the clients’ P&I funds and took corrective action. C1 was reimbursed $14.00 for the undocumented cigarette purchase. Additionally, C1, C2, and C3 were each reimbursed for $18.00 for the purchases that were made without proper client authorization and documentation.

Continue 809C

NAME OF LICENSING PROGRAM MANAGER: Wei Siew Ho
NAME OF LICENSING PROGRAM ANALYST: Nune Margaryan
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 07/16/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/16/2026
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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Document Has Been Signed on 07/16/2026 06:09 PM - It Cannot Be Edited


Created By: Nune Margaryan On 07/16/2026 at 05:30 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: PEOPLE'S CARE CAMERON
FACILITY NUMBER: 198602123

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/16/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
07/20/2026
Section Cited
CCR
80026(h)(1)(B)

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Safeguards for Cash Resources, Personal Property, and Valuables of Residents. Each licensee shall maintain accurate records of accounts of cash resources, personal property, and valuables entrusted to his/her care, including, but not limited to the following: Records of clients' cash resources maintained as a drawing account, which shall include a current ledger accounting, with columns for income, disbursements and balance, for each client. Supporting receipts for purchases shall be filed in chronological order. The store receipt shall constitute the receipt for purchases made for the client from his/her account.

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The administrator will review the regulation to the staff and provide training for them and also write up a plan for how to ensure to maintain accurate records of client's cash resources with receipts for client's P&I monies.
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This requirement was not met as evidenced by: Licensee/Administrator did not maintain accurate and current ledger for C1,C2, and C3. No receipt was available, and the transaction was not recorded on the client's ledger. Commingled Purchase on 12/24/2025. This poses a potential risk to the health, safety, or personal rights of persons in care.
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Type B
07/20/2026
Section Cited
CCR85072(b)(7)

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Personal Rights,The licensee shall insure that each client is accorded the following personal rights.To possess and control his/her own cash resources. This requirement was not met as evidenced by:
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The Administrator will review the regulation with all staff responsible and submit proof of staff training and a written plan describing how the facility will ensure clients are informed of and agree to the use of their P&I funds before any withdrawals are made.
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Based on interviews and record review, the licensee / administrator did not ensure that clients were informed of and agreed to the use of their Personal and Incidental (P&I) funds before deductions were made from their accounts, violating the clients' personal rights.This poses a potential risk to the health, safety, or personal rights of persons in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Wei Siew Ho
NAME OF LICENSING PROGRAM MANAGER:
Nune Margaryan
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 07/16/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/16/2026


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
CCLD Regional Office, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754
FACILITY NAME: PEOPLE'S CARE CAMERON
FACILITY NUMBER: 198602123
VISIT DATE: 07/16/2026
NARRATIVE
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A deficiencies are being cited in accordance with California Code of Regulations, Title 22, Sections 80026(h)(1)(B) and 85072(b)(7). The facility failed to ensure that client P&I funds were properly authorized, documented, and recorded, and failed to ensure that clients were informed of and involved in decisions regarding the use of their personal funds before deductions were made from their P&I accounts.

Exit interview conducted and the copy of the report along with appeal rights were provided to Administrator.

NAME OF LICENSING PROGRAM MANAGER: Wei Siew Ho
NAME OF LICENSING PROGRAM ANALYST: Nune Margaryan
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 07/16/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/16/2026
LIC809 (FAS) - (06/04)
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