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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198602422
Report Date: 10/31/2025
Date Signed: 10/31/2025 01:22:30 PM

Document Has Been Signed on 10/31/2025 01:22 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
GREATER LA AC/SC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754
FACILITY NAME:PEOPLE'S CARE VIOLAFACILITY NUMBER:
198602422
ADMINISTRATOR/
DIRECTOR:		JASMINE ZAMORAFACILITY TYPE:
737
ADDRESS:1605 VIOLA PLTELEPHONE:
(909) 671-4184
CITY:POMONASTATE: CAZIP CODE:
91768
CAPACITY: 3CENSUS: 2DATE:
10/31/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:55 AM
MET WITH:Jasmine Zamora - AdministratorTIME VISIT/
INSPECTION COMPLETED:
01:30 PM
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Licensing Program Analyst (LPA) Bennette Pena conducted an unannounced required 1-year visit. LPA met with Marc Marquez, RBT/Lead and Jasmine Zamora, Administrator and explained the reason for the visit.The facility is licensed for (3) adults, ages 18 - 59, of which 3 may be non-ambulatory. Currently, there are (2) ambulatory clients who are receiving services through San Gabriel/Pomona Regional Center. LPA utilized the Compliance and Regulatory Enforcement (CARE) tools for the visit today and observed the following:

The home consists of three (3) client bedrooms, one (1) office, two (2) bathrooms, living room, den/activity area with covered fireplace, dining room, kitchen with laundry services adjacent to the kitchen area, attached garage and shaded patio area in the back yard. Facility fire clearance is maintained in conformity with State Fire Marshall regulations. The home has automatic fire sprinkler system as required. The home has a working signal system. Client bedrooms were toured. Each bedroom has a smoke detector, bed, linen, dresser, light, chair and sufficient closet space. Smoke alarms and carbon monoxide were tested and operable. All toilets, hand washing, and bathing facilities are safe, sanitary, and in operating condition. Knives, cleaning solutions, and disinfectants are locked and inaccessible to clients. No firearms nor other dangerous weapons are kept at the facility. Disinfectants, cleaning solutions, poisons were inaccessible to clients. Hot water temperature was measured at 118.5 deg F in bathroom #1 and 116.9 deg F in bathroom #2 which is within the Title 22 regulations. There are (2) fire extinguishers, one in the kitchen area and the other one in the office which were last serviced on 10/13/2025. All outdoor and indoor passageways were free of obstruction. Backyard was inspected and has a shaded area and sitting area. There are no cameras in the facility. All food is selected, stored, prepared and served in a safe and healthful manner. Supplies of nonperishable foods are maintained on the premises to last for a minimum of one week and fresh perishable foods for a minimum of two days for the amount of clients being served. All foods are protected against contamination.
***CONTINUED ON LIC809-C***
NAME OF LICENSING PROGRAM MANAGER: David Sicairos
NAME OF LICENSING PROGRAM ANALYST: Bennette Pena
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 10/31/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/31/2025
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
GREATER LA AC/SC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754
FACILITY NAME: PEOPLE'S CARE VIOLA
FACILITY NUMBER: 198602422
VISIT DATE: 10/31/2025
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Surety bond insurance is in effect in the amount of $3000. A total of (27) staff members including the Administrator provide care and supervision to the clients. The licensee employs staff as necessary to ensure provision of care and supervision to meet client's needs. Each client is accorded safe, healthful, and comfortable accommodations, furnishings and equipment to meet their needs.

LPA reviewed (5) staff files including the Administrator. Proof of staff training, health clearance, and vaccinations are current. All staff have a criminal record clearance, fingerprint cleared, have the required training and associated to the facility. Staff responsible for direct care and supervision have current first aid/CPR training. Staff providing night supervision are available to assist in the care and supervision of clients in the event of an emergency and have received the required training. The facility has a certified Administrator with a valid certificate expiring on 12/20/2026.

LPA reviewed (2) client files. Physician's Report (including TB and Ambulatory Status), Consent For Medical Treatment, Special Incident Reports, Client Personal Property and Clients Personal Rights observed. The Regional Center Individualized Personal Plan (IPP) is used in lieu of the needs and services forms. Facility provides internet service and phone to the clients.

LPA reviewed medication for all clients. The facility uses the Medication Administration Record (MAR) log to document medications given. All medications are labeled and are maintained in compliance with label instructions. Medication is kept in a safe and locked place that is not accessible to persons other than staff responsible for the supervision of the centrally stored medication.

The P&I ledgers were also reviewed. Cash resources, personal property and valuables of clients are kept separate and intact, and are not co-mingled with facility funds or petty cash. Disaster drills are conducted every month, the last fire drill was conducted on 10/07/2025 and earthquake drill on 09/17/2025. The facility has a complete Emergency Disaster and Mass Casualty Plan.


No deficiency cited. Exit interview conducted and a copy of this report was provided to Jasmine Zamora, Administrator.
NAME OF LICENSING PROGRAM MANAGER: David Sicairos
NAME OF LICENSING PROGRAM ANALYST: Bennette Pena
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 10/31/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/31/2025
LIC809 (FAS) - (06/04)
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