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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198603174
Report Date: 09/21/2025
Date Signed: 09/21/2025 05:55:38 PM

Document Has Been Signed on 09/21/2025 05:55 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:ALVARADO CARE HOMEFACILITY NUMBER:
198603174
ADMINISTRATOR/
DIRECTOR:		DUNGCA, ROMMELFACILITY TYPE:
735
ADDRESS:1217 S ALVARADO STREETTELEPHONE:
(562) 505-6484
CITY:LOS ANGELESSTATE: CAZIP CODE:
90006
CAPACITY: 46CENSUS: 39DATE:
09/21/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:15 AM
MET WITH:Rommel DungcaTIME VISIT/
INSPECTION COMPLETED:
02:35 PM
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Licensing Program Analyst (LPA) Sandra Urena arrived unannounced at the facility to conduct the required annual inspection. The LPA was greeted by staff and informed them of the reason for the visit. The staff contacted the Administrator Rommel Dungca who arrived shortly thereafter.

LPA Urena, along with the Administrator, toured the physical plant areas inside and outside to ensure there are no health and safety hazards and that facility is in compliance with Title 22 Regulations. The facility has a fire clearance approved for 30 Ambulatory and 16 Non-Ambulatory clients ages 18-59 and six (6) may be bedridden on first floor only). All residents currently are ambulatory residents.
COMMON AREAS: First Floor: front desk office, lobby, living room, dining area, patio, kitchen with pantry, laundry room, 1 visitor restroom, 2 staff office, laundry room, medication room, 2 storage closets, and elevator. Second Floor: Elevator, storage closet, staff lounge “resting room”, 1 staff bathroom, laundry closet, 2 offices used as storage rooms, 1 staff office. The facility maintained a comfortable temperature. Smoke detectors were tested on 07/14/2025 by a private company. The fire extinguishers were observed and located throughout the facility on the first and second floor which were last serviced on 07/22/2025. The LPA observed required postings throughout the common space. The hot water temperature was measured throughout the facilities client bathrooms and were within the required range of 105-120 degrees. All storage areas for cleaning solutions, toxins, knives, and hazardous items are centrally stored and kept locked and inaccessible to clients.

Continues on LIC 809C...

NAME OF LICENSING PROGRAM MANAGER: Kasandra Lopez
NAME OF LICENSING PROGRAM ANALYST: Sandra Urena
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 09/21/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/21/2025
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
MONTEREY PARK ASC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754
FACILITY NAME: ALVARADO CARE HOME
FACILITY NUMBER: 198603174
VISIT DATE: 09/21/2025
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KITCHEN: Knives and cleaning supplies are stored inaccessible to clients. Kitchen appliances were in operable condition. The facility has a sufficient supply of perishable and non-perishable food. Appliance temperatures were recorded at 0 and 37 degrees.

BEDROOMS: The LPA observed the bedrooms and closet/drawer space to accommodate each client comfortably was available. Hygiene products are readily available for clients in care. Residents’ bedrooms were furnished appropriately with clean linens, appropriate furnishings and sufficient lighting.

BATHROOMS: Bathrooms were clean and sanitary and in operating condition with grab bars and non-skid surfaces. The bathrooms were sufficiently stocked with soap. The hot water temperature measured within the regulations.

OUTDOOR AREA: The facility provides a shaded area with outdoor furniture to accommodate residents in care. All passageways, walkways, driveway, steps and patio are free from obstructions.

RECORDS: Records review began at 11:45 a.m. Residents’ records were reviewed for, but not limited to care plans, medical records, admissions agreement, consent forms. All records were in order. Personnel records were reviewed for, but not limited to health assessments, criminal record clearances, first aid/CPR training, and the appropriate training. All files were in order.

MEDICATIONS: Medications review began at 01:45 p.m.; medications are centrally stored and locked in the medication room located on the first floor. Medications are labeled and checked for expiration dates. The medications are documented properly on the centrally stored medications and destruction record. No errors observed during the medication review.



The LPA reviewed the following documents:
- LIC500 Personnel Report
- LIC9020 Client Roster
- Certificate of Liability of Insurance
_ Emergency Drill Logs


No citations were issued at this time. Exit interview conducted. A copy of the report was issued.
NAME OF LICENSING PROGRAM MANAGER: Kasandra Lopez
NAME OF LICENSING PROGRAM ANALYST: Sandra Urena
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 09/21/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/21/2025
LIC809 (FAS) - (06/04)
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