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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198603508
Report Date: 03/18/2025
Date Signed: 03/18/2025 12:48:58 PM

Document Has Been Signed on 03/18/2025 12:48 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:REM CALIFORNIA, LLC - BELLFLOWERFACILITY NUMBER:
198603508
ADMINISTRATOR/
DIRECTOR:		MANALASTAS, ALBERTOFACILITY TYPE:
735
ADDRESS:6129 BELLFLOWER BLVDTELEPHONE:
(562) 866-9634
CITY:LAKEWOODSTATE: CAZIP CODE:
90713
CAPACITY: 4CENSUS: 3DATE:
03/18/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:10 AM
MET WITH:Sasha Camacho, Directe Supoort Professiona TIME VISIT/
INSPECTION COMPLETED:
12:55 PM
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Licensing Program Analysts (LPAs) Mayra Cota and Blanca Gonzalez, conducted an unannounced required annual visit. LPA met with Sasha Camacho, Direct Support Personnel, and explained the reason for the visit. Administrator, Martel Plotnick, arrived thereafter and assisted with the visit.

The facility is licensed to serve 3 ambulatory and 1 non-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 Harbor Regional Center. The facility is in a residential area of Lakewood.

LPAs and Administrator toured the home and inspected the living room, dining room, kitchen, one (1) client bedroom, 2 full bathrooms for clients and staffs, storage closets in both hallways, office and laundry area. Three (3) client bedrooms were not inspected, due to clients resting at the time of visit. The front and backyard, and the detached garage were also inspected. During today’s visit, LPAs observed the following:

Inside the home:
  • The water temperature was tested in both bathrooms and measured at 111.7-degrees F in bathroom 1- and 111.3-degrees F in bathroom 2 which is within the required 105 - 120 degrees F.
  • Client bedroom has the required furniture such as bed frames, dressers, lamps, and chairs. Bedroom also has sufficient closet space. Client bed had the required linen and mattress pads. There is a cabinet in the laundry area in with extra clean linen, towels, and personal hygiene items for clients.
  • 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 are two (2) fire extinguisher located in the facility and where observed to be charged.
***Continues on LIC 809C
SUPERVISORS NAME: Wei Siew Ho
LICENSING EVALUATOR NAME: Mayra Cota
LICENSING EVALUATOR SIGNATURE: DATE: 03/18/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/18/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.

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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: REM CALIFORNIA, LLC - BELLFLOWER
FACILITY NUMBER: 198603508
VISIT DATE: 03/18/2025
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  • Kitchen appliances were clean and were operating at the time of the visit. Sharps are locked in a cabinet in the kitchen and are inaccessible to clients.
  • Cleaning supplies and toxins were locked in a cabinet under kitchen sink.
  • Sufficient supply of 2 day perishable and 7 day non-perishable food was observed and an additional emergency food supply was observed in the garage, however several canned food items were observed to be past the "best if used by" date in the emergency food supply cabinet in the garage.


Outdoor environment:
  • The front and backyard are well maintained and there are no pools or large bodies of water. There is a patio seating area accessible to clients, located in the backyard, however, the canopy was missing the cover.
  • Passageways and exits are free of obstruction.
  • Physical activity equipment was observed to be in good repair and accessible to clients.

Medication and record review:
  • 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 (3) of the client files and medication was reviewed.
  • Three (3) staff files were reviewed.

During today's visit, deficiencies are cited per California Code of Regulations Title 22. LPAs explained the citations and appeal rights.

Exit interview conducted with Martel Plotnick, Administrator and Appeal Rights were provided.
SUPERVISORS NAME: Wei Siew Ho
LICENSING EVALUATOR NAME: Mayra Cota
LICENSING EVALUATOR SIGNATURE:

DATE: 03/18/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/18/2025
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 03/18/2025 12:48 PM - It Cannot Be Edited


Created By: Mayra Cota On 03/18/2025 at 12:05 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 - BELLFLOWER
FACILITY NUMBER: 198603508

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/18/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
80076(a)(1)
80076 Food Service
(a) In facilities providing meals to clients, the following shall apply: (1) All food shall be safe and of the quality and quantity necessary to meet the needs of the clients. Each meal shall meet at least 1/3 of the servings recommended in the USDA Basic Food Group Plan - Daily Food Guide for the age group served. All food shall be selected, stored, prepared and served in a safe and helthful manner.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, the licensee did not comply with the section cited above in that several canned food items were observed to be past the "best if used by" date in the emergency food supply cabinet in the garage which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 03/21/2025
Plan of Correction
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Licensee will purchase canned food to replenish supply and continuously check all 'best if used by" dates. LIcensee will conduct regular rotation of canned food items to ensure food is used by "best if used by" dates. Licensee will send LPAs purchase receipts of canned food items by POC due date.
Type B
Section Cited
CCR
85087.2(b)
85087.2 Outdoor Activity Space
(b) The outdoor activity area shall provide a shaded are and shall be comfortable and furnished for outdoor use.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, the licensee did not comply with the section cited above in that the canopy in the patio area was missing the cover which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 03/25/2025
Plan of Correction
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Licensee will purchase a canopy cover and install by the POC due date. Licensee will send LPA purchse receipt and photo of the intalled canopy cover.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Wei Siew Ho
LICENSING EVALUATOR NAME:Mayra Cota
LICENSING EVALUATOR SIGNATURE:
DATE: 03/18/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/18/2025


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