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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198603462
Report Date: 07/21/2026
Date Signed: 07/21/2026 12:40:32 PM

Document Has Been Signed on 07/21/2026 12:40 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:CARING HEARTS HOMESFACILITY NUMBER:
198603462
ADMINISTRATOR/
DIRECTOR:		CLARINDA ROAFACILITY TYPE:
735
ADDRESS:18120 PUENTE ROADTELEPHONE:
(714) 398-4409
CITY:LA PUENTESTATE: CAZIP CODE:
91744
CAPACITY: 6CENSUS: 5DATE:
07/21/2026
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:09 AM
MET WITH:Monaliza Quan - Direct Care Staff
May Rioflorido - Direct Care Staff 		TIME VISIT/
INSPECTION COMPLETED:
12:45 PM
NARRATIVE
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Licensing Program Analyst (LPA) Bennette Pena conducted an unannounced Required-1 year visit. LPA was met by May Rioflorido, Direct Care staff and explained the purpose of today's visit. The administrator, Clarinda Roa was informed of the visit by phone. At 11:30am, Monaliza Quan, Direct Care staff arrived and assisted LPA. The facility is licensed to serve developmentally disabled adults ages 18-59 years old, (6) ambulatory, of which (2) may be non ambulatory. The home is vendorized through the San Gabriel Pomona Regional Center. Currently there are (5) ambulatory clients. LPA utilized the Compliance and Regulatory Enforcement (CARE) tools for the visit today and observed the following:

Staff are adhering to infection control requirements. The facility has submitted the Infection Control Plan. The facility is a single story home consists of (4) client bedrooms, (1) staff bedroom, (1) office, (2 1/2) bathrooms, kitchen, dining room, living room, attached garage with laundry area, backyard with covered patio. Client bedrooms were toured. Each bedroom has a smoke detector, bed, linen, dresser, light, chair and sufficient closet space. Smoke alarms and carbon monoxide were tested and operable. Knives, cleaning solutions, and disinfectants are locked and inaccessible to clients. There are no firearms or weapons stored at the facility. Hot water temperature in the bathroom was checked (3x), nand measured at 78.8 deg F @10:45am, 77.9 deg F @ 10:50 am and 78.1 deg F @ 11am, which did not meet the required 105 degrees F and not more than 120 degrees F. There are no pools or large bodies of water. Backyard was inspected and it has a shaded sitting area. There were pails of paints stored in the sideyard which can be a hazardous obstruction. LPA observed a fire extinguisher in the kitchen which was recently serviced on 07/13/2026. Surety bond insurance in the amount of $4000 is in effect. Disaster drills are conducted on a quarterly basis, the last fire drill was conducted on 06/07/2026. *****Continued on LIC 809C*****

Lisa Hicks
Bennette Pena
DATE: 07/21/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/21/2026
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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Document Has Been Signed on 07/21/2026 12:40 PM - It Cannot Be Edited


Created By: Bennette Pena On 07/21/2026 at 12:22 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754

FACILITY NAME: CARING HEARTS HOMES
FACILITY NUMBER: 198603462

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/21/2026

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
80088(e)(1)
Fixtures, Furniture, Equipment, and Supplies
(1) Hot water temperature controls shall be maintained to automatically regulate temperature of hot water delivered to plumbing fixtures used by clients to attain a hot water temperature of not less than 105 degrees F (40.5 degrees C) and not more than 120 degrees F (48.8 degrees C).

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, the Administrator did not comply with the section cited above in that hot water temperature in bathroom #1 was checked (3x), and measured at 78.8 deg F @10:45am, 77.9 deg F @ 10:50 am and 78.1 deg F @ 11am, which did not meet the required 105 degrees F and not more than 120 degrees F which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 07/21/2026
Plan of Correction
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Staff adjusted the hot water control to meet the required 105 degrees F and not more than 120 degrees F hot water temperature range. *****DEFICIENCY CLEARED DURING THE VISIT.*****
Type B
Section Cited
HSC
1562.5(a)
Other Provisions
(a) The director shall ensure that, within six months after obtaining licensure, an administrator of an adult residential facility and a program director of a social rehabilitation facility shall receive four hours of training on the needs of residents who may be infected with the human immunodeficiency virus (HIV), and on basic information about tuberculosis. Administrators and program directors shall attend update training sessions every two years after satisfactorily completing the initial training to ensure that information received on HIV and tuberculosis remains current. The training shall consist of three hours on HIV and one hour on tuberculosis.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on interview, record review, the Administrator did not comply with the section cited above in that the administrator did not have a valid HIV/TB training which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 08/04/2026
Plan of Correction
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Administrator to either send a copy of the valid HIV/TB training certificate or send proof that training has been scheduled.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Lisa Hicks
NAME OF LICENSING PROGRAM MANAGER:
Bennette Pena
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 07/21/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/21/2026


LIC809 (FAS) - (06/04)
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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: CARING HEARTS HOMES
FACILITY NUMBER: 198603462
VISIT DATE: 07/21/2026
NARRATIVE
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A total of (10) staff members including the Administrator provide care and supervision to the clients. Staff employed are over the age of 18 and have criminal background clearance, fingerprint cleared, have training and associated to the facility. Administrator's certificate is valid and expires on 01/04/2027. Administrator does not have a valid HIV/TB training. The licensee employs staff as necessary to ensure provision of care and supervision to meet client's needs. Each client is accorded safe, healthful, and comfortable accommodations, furnishings and equipment to meet their needs. LPA reviewed (5) staff files including the administrator. Proof of staff training, health clearance, and vaccinations are current. Client personal rights are posted. Facility provides internet service and phone to the clients. LPA reviewed (5) client files. Client files are maintained at the facility. Admission Agreement, Physician's Report (including TB and Ambulatory Status), Consent for Medical Treatment, Client Personal Property and Clients Personal Rights observed. There are sufficient food supplies of 2-day perishable and 7-day supplies of non-perishable items. All foods are protected against contamination. There are no clients with special diets residing at this facility. LPA reviewed medication for the clients. The medications are centrally stored and in their original containers. The facility uses Medication Administration Record (MAR) to document medications are administered as prescribed by the Physician. There are no client at this home with a restricted health condition. The facility has a complete Emergency Disaster and Mass Casualty Plan.

Deficiencies cited and Technical advisories issued. Exit interview was conducted with the administrator, Clarinda Roa by phone and a copy of this report was provided to Monaliza Quan, Direct Care Staff.

NAME OF LICENSING PROGRAM MANAGER: Lisa Hicks
NAME OF LICENSING PROGRAM ANALYST: Bennette Pena
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 07/21/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/21/2026
LIC809 (FAS) - (06/04)
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