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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198602617
Report Date: 04/03/2026
Date Signed: 04/03/2026 04:34:15 PM

Document Has Been Signed on 04/03/2026 04:34 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
EL SEGUNDO ASC, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754
FACILITY NAME:CRANBROOK HOUSEFACILITY NUMBER:
198602617
ADMINISTRATOR/
DIRECTOR:		OROSZ, TAMIFACILITY TYPE:
735
ADDRESS:18819 CRANBROOK AVENUETELEPHONE:
(310) 516-8134
CITY:TORRANCESTATE: CAZIP CODE:
90504
CAPACITY: 4CENSUS: 4DATE:
04/03/2026
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:20 PM
MET WITH:Maria DiazTIME VISIT/
INSPECTION COMPLETED:
04:45 PM
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On 04/03/2026, Licensing Program Analysts (LPA), Wendy Gibbs, conducted an unannounced Annual Visit using the CARE Inspection Tool. LPA met with House Manager, Maria Diaz, and the purpose of today’s visit was explained. LPA was granted entry into the facility.
The facility is licensed to serve four (4) ambulatory adults ages 18 through 59. Clients are Harbor Regional Center clients. During the time of visit there were four (4) clients present.
Structure/Physical Plant The facility is a single-story structure located in a residential neighborhood. The facility consists of four (4) client bedrooms, two (2) resident bathrooms, living room, dining area, staff office area, kitchen, laundry area, attached garage, and a backyard with a table, chairs, and umbrella. LPA observed all walkways outside the facility are clean, clear, and free of debris, obstruction, and hazards. LPA did not observe any bodies of water on the premises.
Bedrooms LPA inspected all Client bedrooms. LPA observed the bedrooms to be clean and in good repair. LPA observed all rooms have the required items including a bed, dresser, nightstand, chair, and storage space for personal belongings. LPA observed the beds have the required bedding including a mattress cover, fitted sheet, flat sheet, blanket, comforter, and pillows. LPA observed an ample supply of linens in good repair. LPA observed all bedrooms have ample lighting.
Bathrooms All bathrooms were observed to be within Title 22 regulation and are operable. Showers were observed free of mold/mildew and had non-skid mats. LPA observed an ample supply of toiletries for clients. The water temperature measured 112.5-degrees and 113.8-degrees Fahrenheit.
Kitchen LPA observed the kitchen to be clean and sanitary. All appliances are operational and in good
repair. LPAs observed an ample supply of dishware, cookware, and cutlery. LPA observed a 3-day supply
NAME OF LICENSING PROGRAM MANAGER: Eva M Alvarez
NAME OF LICENSING PROGRAM ANALYST: Wendy Gibbs
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 04/03/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/03/2026
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
EL SEGUNDO ASC, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754
FACILITY NAME: CRANBROOK HOUSE
FACILITY NUMBER: 198602617
VISIT DATE: 04/03/2026
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of perishable foods and a 7-day supply of non-perishable foods properly packaged, stored, and labeled. All sharps were observed secured in a locked cabinet in the hallway and are inaccessible to clients. LPA observed cleaning supplies secured in a locked cabinet in the hallway and are inaccessible to clients. The water temperature measured 113.6-degrees Fahrenheit.
Common Rooms LPA observed the living room has two couches to accommodate clients. The dining room and kitchen have tables and chairs to accommodate all clients. LPA observed games, puzzles, reading material and activities in a bookcase in the dining room and client rooms. The facility was observed to be properly furnished during time of visit. All walkways and hallways were observed clean, clear, free of hazards and obstructions. All rooms and hallways have ample lighting. The facility was maintained at a comfortable temperature.
File Review LPA reviewed four (4) client files and observed them to have the required documents. LPA reviewed the residents P & I documents and receipts. LPA reviewed the Administrator and three (3) staff files and observed them to have the required training, certifications, clearance, and documents. LPA observed the administrator’s Administrator Certificate, number 7003747735, is valid till 01/18/2028. The facility has a Surety bond through Nation Wide. LPA observed the Licensing Fees are current.
Medications LPA observed Centrally Stored Medications secured in a locked cabinet in the hallway and are inaccessible to clients. Medications were observed in their original containers. LPA reviewed the medications and Medication Administration Records (MAR) for four (4) clients. LPA observed four (4) out of four (4) clients MARs and medication are consistent with properly documented records.
Safety LPA observed smoke detectors and carbon monoxide detectors are operable. LPAs observed two fully charged fire extinguishers last serviced on 07/21/2025. The last emergency drill was conducted on 03/27/2026. The facility's disaster plan is current and in compliance with Title 22. LPA inspected the First Aid Kit and observed it had the required items and a current First Aid manual. The facility has a working landline telephone. All required posting were observed in the office area.
Infection Control LPA observed the facility has an Infection Control Plan. LPA observed infection control signs posted throughout the facility. LPA observed an ample supply of cleaning supplies. LPA observed a 90-day supply of Personal Protective Equipment (PPE) stored in the garage.

According to the California Code of Regulations (Title 22, Division 6, Chapter 8), LPA did not observe any deficiencies therefore no citations were issued at this time.


An exit interview was conducted with House Manager, Maria Diaz and a copy of this report was provided.
NAME OF LICENSING PROGRAM MANAGER: Eva M Alvarez
NAME OF LICENSING PROGRAM ANALYST: Wendy Gibbs
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 04/03/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/03/2026
LIC809 (FAS) - (06/04)
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