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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198603505
Report Date: 12/04/2025
Date Signed: 12/04/2025 05:13:29 PM

Document Has Been Signed on 12/04/2025 05:13 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
GREATER LA AC/SC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754
FACILITY NAME:REM CALIFORNIA, LLC - GLENWOODFACILITY NUMBER:
198603505
ADMINISTRATOR/
DIRECTOR:		VANESSA VASQUEZFACILITY TYPE:
735
ADDRESS:2418 GLENWOOD PLACETELEPHONE:
(323) 249-8299
CITY:SOUTH GATESTATE: CAZIP CODE:
90280
CAPACITY: 4CENSUS: 4DATE:
12/04/2025
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
04:20 PM
MET WITH:Stacey Cheat - AdministratorTIME VISIT/
INSPECTION COMPLETED:
05:30 PM
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Licensing Program Analyst (LPA) Tena Herrera conducted an unannounced Case Management- Incident visit on 12/04/2025, regarding two Special Incident Reports (SIR’s), one received on 11/13/2025 and the other on 12/3/25. LPA was greeted by Stacey Chet and explained the purpose of the visit.

Case Management-Incident Findings:

On 11/13/35 the department received an SIR stating that on 11/12/25 REM California Quality Improvement Manager conducted a review of P&I funds and observed that Client #1 (C1) had three ATM cash withdrawals that were unaccounted for: on 9/16/25 $200 and on 10/10/25 $200 & $100, additionally C1’s cash on hand balance was $20 short of the balance documented on their cash ledger. Client #2 (C2) had debit card had unknown transaction attempts with no funds withdrawn: including a Cash App on 5/13/25.
    LPA spoke with Quality Improvement Manager (QIM) Matt Robins and they confirmed that the internal investigation facility has done did not find where or how these funds became missing, the bank has since replaced cards for both clients, and C1’s bank has reimbursed the missing funds. Facility is currently working on creating a work order for C1 to have the $20 cash reimbursed. Matt also confirmed that C2 did not have any missing funds, the bank blocked the attempted Cash App transaction prior to any potential fraud from occurring.

(Continued on LIC809-C)
NAME OF LICENSING PROGRAM MANAGER: David Sicairos
NAME OF LICENSING PROGRAM ANALYST: Tena Herrera
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 12/04/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/04/2025
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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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
GREATER LA AC/SC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754
FACILITY NAME: REM CALIFORNIA, LLC - GLENWOOD
FACILITY NUMBER: 198603505
VISIT DATE: 12/04/2025
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On 12/3/25 the department received an SIR stating that on 11/20/25 REM California Quality Improvement Manager (QIM) conducted a review of medication and multiple errors such as documentation errors were observed. Order needing clarification, Medication ordered that had not yet been picked up from the pharmacy and dosage medication errors. During the review it had been found that Clients 1-3 (C1-C3) had multiple errors with their medication. On 11/20/25 C1’s 12pm medication was not signed for in the Medication Administration Record or in ECP (electronic med chart), another medication was found in bubble packaging and not popped/administered on 11/21/25, on 11/26/25 medication was withheld by C1’s mom due to a dental procedure with no doctors order authorizing medication hold and 13 medications were missed that day. On 12/21/25 C2 had medication documentation errors found for 5PM medication on the following dates:11/3, 11/4, 11/6, 11/7, 11/13, 11/14, 11/18, 11/19, 11/21. On 11/19/25 C3 error was found that medication pill was cut in half and was administered, 11/21 an AM medication was not administered. 11/24 staff reported PM 1 ½ medications were still in bubble pack and not administered.

    Per Area Director Von’Eric Johnson and Administrator Stacey Cheat, physicians were notified and all medication have since been accounted for and administered as prescribed by physician. Per Von’Eric staff that were responsible for errors have since been removed from medication administration duties until they are retrained, there is a training with Pharmacy scheduled for 12/23/25 where all staff will be re-trained in medication administration and facility has an RN from one of their sister facilities that has come in to do a medication review and make sure all clients are taking the medication as prescribed.


LPA is issuing citations for both the client fund errors and medication errors during todays visit, details can be found on the attached 809-D page.

Exit Interview held and a copy of the report and appeal rights were provided.
NAME OF LICENSING PROGRAM MANAGER: David Sicairos
NAME OF LICENSING PROGRAM ANALYST: Tena Herrera
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 12/04/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/04/2025
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 12/04/2025 05:13 PM - It Cannot Be Edited


Created By: Tena Herrera On 12/04/2025 at 04:25 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: REM CALIFORNIA, LLC - GLENWOOD
FACILITY NUMBER: 198603505

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/04/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
12/05/2025
Section Cited
CCR
80065(a)

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80065 Personnel Requirements (a) Facility personnel shall be competent to provide the services necessary to meet individual client needs and shall, at all times, be employed in numbers necessary to meet such needs. This requirement was not met as evidence by:
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Licensee/Administrator to conduct a training for all staff that assist with medication. Copies of training materials and participant log is to be sent to LPA upon completion of the training, by 12/24/25.
*Area Director Von'Eric sent LPA proof that the training has been scheduled with Parmacy and has a training date of 12/23/25*
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Per Incident Report received on 12/3/25 and conversation with Area Director Von'Eric and Administrator Stacey Cheat there were multiple medications errors and documentation errors found for clients 1-4.
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Type B
12/26/2025
Section Cited
CCR80026(h)(1)

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80026 Safeguards for Cash Resources, Personal Property, and Valuables of Residents (h) Each licensee shall maintain accurate records of accounts of cash resources, personal property, and valuables entrusted to his/her care, including, but not limited to the following: (1) Records of clients' cash resources maintained as a drawing account, which shall include a current ledger accounting, with columns for income, disbursements and balance, for each client. Supporting receipts for purchases shall be filed in chronological order. This requirement was not met as evidence by:
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Licensee/Administrator to conduct a training for all staff on the Safe Guards for Cash Resouces and provide a copy of the training materials and participant log to LPA via email by POC due date. Additionally the entire regulation 80026 Safeguards for Cash Resources, Personal Property, and Valuables of Residents is to be reviewed and a signed copy of the POC form LIC9098 (signed by Area Director and Administrator) is to be emailed to LPA by POC due date.
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Per Incident Report received on 11/13/25 and conversation with Quality Improvement Manager Matt Robins, C1 had three ATM cash withdrawals that were unaccounted for: on 9/16/25 $200 and on 10/10/25 $200 & $100, additionally C1’s cash on hand balance was $20 short of the balance documented on their cash ledger.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
David Sicairos
NAME OF LICENSING PROGRAM MANAGER:
Tena Herrera
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 12/04/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/04/2025


LIC809 (FAS) - (06/04)
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