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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198602879
Report Date: 07/23/2025
Date Signed: 07/23/2025 05:07:58 PM

Document Has Been Signed on 07/23/2025 05:07 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:SOUTH BAY CIRCLE OF FRIENDS INCFACILITY NUMBER:
198602879
ADMINISTRATOR/
DIRECTOR:		QUAN, MARIAFACILITY TYPE:
735
ADDRESS:18509 S ILLINOIS CTTELEPHONE:
(310) 715-1828
CITY:TORRANCESTATE: CAZIP CODE:
90504
CAPACITY: 5CENSUS: 4DATE:
07/23/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:59 PM
MET WITH:TIME VISIT/
INSPECTION COMPLETED:
05:00 PM
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On 07/23/25, Licensing Program Analyst (LPA), Wendy Gibbs, conducted an unannounced annual visit to the facility listed above. LPA met with Staff, Calvin Fortune, and the purpose of today was explained. We were joined by Administrator Suyono ‘John’ Wong and Mariel Ventura and Program Manager, Hai Nguyen. The facility is licensed to serve five (5) ambulatory clients ages 18 through 59. Currently the facility has four (4) clients residing in the facility.
Physical Plant/Structure The facility is a single-story structure in a residential neighborhood. It consists of four (4) bedrooms, two (2) bathrooms, two (2) living areas, dining area, kitchen, office area, attached garage, and an outside shaded patio. LPA observed the patio has a table and chairs available for client use. LPA observed all walkways around the facility are clean, clear, and free of debris, hazards, and obstructions. LPA did not observe any bodies of water on the premises.
Bedrooms LPA inspected all rooms and found them to be clean and in good repair. LPA observed the rooms have the required furniture including a bed, dresser, nightstand, chair, and storage space for personal belongings. LPA observed the beds have the required linens including a mattress cover, fitted sheets, blanket, comforter, and pillows. LPA observed an additional supply of linens stored in a cabinet and additional linens are stored in Client rooms in a cupboard above the closet. All linens and mattresses were observed in good repair. All rooms were observed to have ample lighting.
Bathrooms LPA observed all bathrooms to be operable and within Title 22 regulations. The toilets, faucets, and showers work properly. The bathrooms were observed clean. The showers were observed with secured safety handrails and nonskid mats or material. The showers were observed to be free of mold and mildew. LPA observed storage space for residents’ hygiene products. LPA observed an ample supply of towels and hygiene products available for clients. The water temperature measured 109.2-degrees and 108.6-degrees Fahrenheit.
NAME OF LICENSING PROGRAM MANAGER: Eva M Alvarez
NAME OF LICENSING PROGRAM ANALYST: Wendy Gibbs
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 07/23/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/23/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 3
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: SOUTH BAY CIRCLE OF FRIENDS INC
FACILITY NUMBER: 198602879
VISIT DATE: 07/23/2025
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Kitchen LPA observed the kitchen to be clean and sanitary. LPA observed all appliances to be operable. LPA observed an ample supply of cookware, dishware, and cutlery. LPA observed a 3-day supply of perishable foods and a 7-day supply of nonperishable foods, properly labeled, packaged, and stored. LPA observed knives and sharps secured in a locked drawer in the kitchen and are inaccessible to clients. LPA observed a sample menu posted in the pantry. LPA observed cleaning supplies to be secured in a cabinet under the kitchen sink and are inaccessible to clients. The water temperature measured 107.2-degrees Fahrenheit.
Common Rooms The facility was observed to be appropriately furnished during the time of visit. One living room had two couches and a swing chair to accommodate Clients. The second living room two has two (2) couches, a desk with a computer, and a bookcase with games and activities. The dining room has a table and chairs to accommodate all clients. LPA observed a screened fireplace that is inaccessible to clients. All walkways and hallways in the home were observed clean, clear, and free of hazards and obstructions. LPA observed all rooms and hallways to have ample lighting. The facility was kept at a comfortable temperature.
File Review LPA reviewed the files for four (4) clients and found they contained the required documents. LPA reviewed the Administrator file, and three (3) staff files and found they contained the required documents, certification, clearance, and training. LPA observed the administrator’s Administrator Certificate is valid till 10/25/25. LPA reviewed clients P&I Ledger, money and receipts for four (4) clients. LPA observed four (4) out of four (4) clients ledgers and monies are accurate and properly documented. LPA observed licensing fees are current.
Safety LPA observed the smoke detectors and carbon monoxide detectors to be operable. LPA observed a fully charged fire extinguisher last serviced on 03/28/25, located in the kitchen. The last Fire Prevention Inspection from the Torrance Fire Department was on 12/10/2024. The last emergency drill was conducted on 07/05/25. The facility has a working landline telephone. LPA observed the facility’s Emergency and Disaster Plan posted and last updated on 04/15/2025. LPA observed all required posting, posted throughout the facility. There are no firearms or ammunition kept on the premises.
Medications LPA observed medications secured in a locked cabinet in the pantry and are inaccessible to Clients. LPA observed medications are in their original packaging. LPA reviewed the medications and Medication Administration Record (MAR) for four (4) clients. LPA observed four (4) out of four (4) client’s MARs and medication are consistent with properly documented records.
Infection Control In the entrance, LPA observed a sanitizing station that consist of hand sanitizer, gloves, and face masks. LPA observed a 30-day supply of Personal Protective Equipment (PPE). LPA observed all required infection control signs posted throughout the facility.
LPA did not observe or cite any deficiencies. An exit interview conducted with, Administrator Suyono ‘John’ Wong and Mariel Ventura, 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: 07/23/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/23/2025
LIC809 (FAS) - (06/04)
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