<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198602916
Report Date: 03/13/2025
Date Signed: 03/13/2025 11:26:27 AM

Document Has Been Signed on 03/13/2025 11:26 AM - 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:CASA KLINEDALEFACILITY NUMBER:
198602916
ADMINISTRATOR/
DIRECTOR:		MENENDEZ, SAMIRAFACILITY TYPE:
735
ADDRESS:9243 KLINEDALE AVENUETELEPHONE:
(562) 440-7531
CITY:DOWNEYSTATE: CAZIP CODE:
90240
CAPACITY: 4CENSUS: 3DATE:
03/13/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:42 AM
MET WITH:Celia Sanchez, Direct Support PersonnelTIME VISIT/
INSPECTION COMPLETED:
11:35 AM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
Licensing Program Analyst (LPA) Mayra Cota conducted an unannounced required annual visit today. LPA met with Celia Sanchez, Direct Support Personnel, and explained the reason for the visit. Administrator, Samira Menendez, arrived thereafter and assisted with the visit.

The facility is licensed to serve 4 ambulatory developmentally disabled adults ages 18 to 59 years old. The facility is operating within the scope of its license. Clients receive services through the South-Central Regional Center. The facility is in a residential area of Downey.

LPA and Administrator toured the home and inspected the living room/dining area, kitchen, 3 client bedrooms, 2 full bathrooms for client and staff use, storage closets in hallway, front yard, backyard, and attached garage/laundry area. During today’s visit, LPA observed the following:

Inside the home:
  • Facility is clean and furniture was observed to be in good repair.
  • Client bedrooms have the required furniture such as bed frames, dressers, lamps, and chairs. Bedrooms also have sufficient closet space. Client beds have the required linen and mattress pads. There is a closet in the hallway with extra clean linen, towels, and personal hygiene items for clients.
  • The water temperature was tested in both bathrooms and measured at 118.7 degrees F in bathroom 1 and 119.4 degrees F in bathroom 2 which is within the required 105 - 120 degrees F.
  • Kitchen appliances were clean and were operating at the time of the visit. Sharps are locked in a closet by the kitchen and are inaccessible to clients.
  • Cleaning supplies and toxins were locked in a cabinet under kitchen sink.

***Continues on LIC 809C
SUPERVISORS NAME: Wei Siew Ho
LICENSING EVALUATOR NAME: Mayra Cota
LICENSING EVALUATOR SIGNATURE: DATE: 03/13/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/13/2025
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 2
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK ASC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754
FACILITY NAME: CASA KLINEDALE
FACILITY NUMBER: 198602916
VISIT DATE: 03/13/2025
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
  • Sufficient supply of 2 day perishable and 7 day non-perishable food was observed and an additional emergency food supply was observed properly stored in the garage. Food is labeled and kept within expiration limits.
  • Smoke detectors were observed throughout the facility and were tested and observed to be working properly. A carbon monoxide detector located in the dining area was tested and was also observed to be working properly.
  • There is one fire extinguisher located by the kitchen and was observed to be charged. The fire extinguisher was last inspected on 9/11/2024. Last fire/safety drill was conducted on 2/10/25.


Outdoor environment:
  • The front and backyard are well maintained and there are no pools or large bodies of water. There is a shaded seating area on the patio deck and is accessible to clients.
  • Passageways and exits are free of obstruction.


Medication and record review:
  • All three of the client files and medication were reviewed.
  • Client medication and files are centrally stored in a locked cabinet in the living room, and staff files are kept locked in a file cabinet in the dining area.
  • Three staff files were also reviewed.

Per California Code of Regulations, Title 22, and California Health and Safety Code, no deficiencies are cited today. Exit interview conducted with Celia Sanchez, DSP and a copy of the report was provided.
SUPERVISORS NAME: Wei Siew Ho
LICENSING EVALUATOR NAME: Mayra Cota
LICENSING EVALUATOR SIGNATURE:

DATE: 03/13/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/13/2025
LIC809 (FAS) - (06/04)
Page: 1 of 1