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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198602901
Report Date: 03/20/2025
Date Signed: 03/20/2025 01:58:46 PM

Document Has Been Signed on 03/20/2025 01:58 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
MONTEREY PARK ASC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754
FACILITY NAME:LAYMAN FACILITYFACILITY NUMBER:
198602901
ADMINISTRATOR/
DIRECTOR:		HERNANDEZ, YESSICAFACILITY TYPE:
735
ADDRESS:4117 LAYMAN AVENUETELEPHONE:
(323) 346-3450
CITY:PICO RIVERASTATE: CAZIP CODE:
90660
CAPACITY: 4CENSUS: 3DATE:
03/20/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:52 AM
MET WITH:Edgar Hernandez-TIME VISIT/
INSPECTION COMPLETED:
01:30 PM
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Licensing Program Analyst (LPA) Sanjay Vaid made an unannounced annual inspection within the Compliance and Regulatory Enforcement Tools. On today’s visit LPA met with Co-Administrator Edgar Hernandez-Jimenez and the purpose of the visit was discussed. Edgar's certificate expires 01/28/2026.

During the inspection, LPA Vaid utilized the inspection domain tools, reviewed three (3) client records and client medications, five (5) staff files reviewed contained the following: current First Aid/CPR/AED/CPI and sufficient on-going training. The facility is vendorized through Eastern Los Angeles Regional Center. Currently, the facility has (3) ambulatory clients.
Facility is a single-story family home with three (3) bedrooms of which one (1) is for live in staff. There are (2) bathrooms of which one (1) is for client use. There is a living room, a den, a kitchen, central air/ heating thru out the facility, a dining area, fireplace is locked with barrier and is inaccessible to the clients, a laundry room, a shaded patio area located in the backyard. A detached two (2) car garage located in the rear of the property is inaccessible to the clients. Front yard is fenced, and both front and back yards are in good condition at time of visit. Washer/Dryer appliances observed and operational. Toxins and sharps locked and inaccessible to clients. Bedrooms #1-#2 are equipped with two (2) beds each, a dresser, lamp, chair, overhead lightning per client. Bedroom #3 is for live in staff/office space. Clients’ bathroom #1 has a working toilet, wash basin, and shower. Water temperature for kitchen and bathroom #1 is within 105-120 degrees F. Bathroom #2 is attached to live in staff room. Beds have the required linen which include, pillowcase, mattress padding, fitted sheet, blanket and bedspreads. Supply of hygiene supplies stored in each client's bedrooms were observed. Fire alarms are interconnected and operational. Required postings observed in the hallway /dining area. Fire alarms were tested and operational. Fire extinguishers last serviced 08/24/2024.

Inspection tool completed and there were no deficiencies noted on today's visit. Three clients are at their day programs. An exit interview was conducted, and a copy of this report was provided to Co-Administrator Edgar Hernandez-Jimenez.
SUPERVISORS NAME: Fernando Fierros
LICENSING EVALUATOR NAME: Sanjay Vaid
LICENSING EVALUATOR SIGNATURE: DATE: 03/20/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/20/2025
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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