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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198603181
Report Date: 06/19/2026
Date Signed: 06/19/2026 05:06:30 PM

Document Has Been Signed on 06/19/2026 05:06 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:CROSSDALE RESIDENTIAL HOME, INCFACILITY NUMBER:
198603181
ADMINISTRATOR/
DIRECTOR:		REDJAL, IVY GFACILITY TYPE:
735
ADDRESS:15209 CROSSDALE AVENUETELEPHONE:
(714) 883-8349
CITY:NORWALKSTATE: CAZIP CODE:
90650
CAPACITY: 4CENSUS: 4DATE:
06/19/2026
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
02:14 PM
MET WITH:Administrator- Ivy RedialTIME VISIT/
INSPECTION COMPLETED:
05:00 PM
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Licensing Program Analysts (LPA) Elena Mallett arrived at the facility to conduct an unannounced Annual visit . LPA met with staff in charge Quinavi Daivd and the purpose of the visit was explained. Quinavi David contacted Administrator Ivy Redial by telephone and Administrator joined the visit shortly after. The facility is licensed to serve four (4) non- ambulatory clients between the ages of 18 through 59.

The facility is a single-story home, located in a residential area of Norwalk that consists of a living room, dining area, a kitchen, three (3) client bedrooms, dining room, living room( 1) one staff room (2) bathrooms, an detached garage, a front yard and a backyard with a covered shaded area with seating.

LPA completed the visit using Compliance and Regulatory Enforcement Tools (CARE) . The following domains were completed during the visit

Infection Control: Infection Control Plan was reviewed by LPA. Facility follows title 22 regulations and is cleaning and disinfecting regularly. Staff has PPE and practices hand hygiene. Facility has designated Infection Control lead.

Physical Plant and Environmental Safety: Physical plant is clean and sanitary and the hallways and walkways are free from debris and obstruction. Hot water temperature measured within Title 22 regulations of 105F-120F in the bathrooms. Facility has smoke and carbon monoxide detectors that were tested and operational. A fully charged fire extinguisher was present near the kitchen. Sharps and toxins are locked in cabinets. Client bedrooms had required light and furnishings. Extra linens and blankets were observed. The backyard area is free of debris and obstruction. A shaded patio area was available for clients to enjoy the outdoors.

Continued on 809-C

NAME OF LICENSING PROGRAM MANAGER: Fernando Fierros
NAME OF LICENSING PROGRAM ANALYST: Elena Mallett
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 06/19/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/19/2026
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
MONTEREY PARK ASC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754
FACILITY NAME: CROSSDALE RESIDENTIAL HOME, INC
FACILITY NUMBER: 198603181
VISIT DATE: 06/19/2026
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Operational Requirements: Fire clearance approval was observed. Plan of operation was observed. Outdoor activity space with a furnished, shaded area was present. Activity supplies for clients were observed such as puzzles and crafts. A monthly activity calendar was provided. Clients attend Day Program and on the weekend staff take clients on outings such as community walks to the parks, to the mall and to religious services.

Client Records - Incident Reports: Locked Storage space for client files was observed. Clients’ files were reviewed for Emergency Face sheet, Physician’s Report with ambulatory status, Needs and Services plan, Admission Agreement and Personal Rights. Files for all four clients in care were reviewed and no issues were observed.

Client Rights - Information: Required postings were observed. A facility telephone and internet are present and available for client use.

Food Service: Kitchen had functional appliances and was equipped to store and prepare food. 2 day perishable and 7 day non perishable food supply were observed. Food was kept separate from cleaners, toxins and poisons. A sample menu was provided.

Disaster Preparedness: Facility has emergency disaster plan in place. Two relocation sites are listed along with emergency shut off locations and designated emergency staff roles. Facility conducts monthly disaster drills. The last drill was conducted on 05/07/26. Facility had several flashlights and emergency supply of water and food. A full first aid kit and manual were observed to be present.

Due to time constraints LPA will need to return to the facility at a later date to complete the remainder of the domains in the CARE tool.

No deficiencies were cited today per Title 22 regulations.

An exit interview was conducted with Administrator Ivy Redial and a copy of this licensing report was provided.

NAME OF LICENSING PROGRAM MANAGER: Fernando Fierros
NAME OF LICENSING PROGRAM ANALYST: Elena Mallett
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 06/19/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/19/2026
LIC809 (FAS) - (06/04)
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