198603569-9-9-2025-28-AS-CGUZ-DLCQS8-20250909122507

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 198603569
Report Date: 09/09/2025
Date Signed: 09/09/2025 12:25:17 PM

Document Has Been Signed on 09/09/2025 12:25 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:	CENTRAL STAR RANCHO LOS AMIGOS CRISIS RESIDENTIAL		FACILITY NUMBER:	198603569
ADMINISTRATOR/ DIRECTOR:	HONORE HARRELL, ALISHA		FACILITY TYPE:	772
ADDRESS:	7745 LEEDS STREET		TELEPHONE:	(562) 719-2866
CITY:	DOWNEY	STATE: CA	ZIP CODE:	90242
CAPACITY: 16		CENSUS: 13	DATE:	09/09/2025
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	09:25 AM
MET WITH:	Janelly Reyes Program Director		TIME VISIT/ INSPECTION COMPLETED:	12:35 PM

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Licensing Program Analyst (LPA) Christian Gutierrez conducted the required annual inspection. LPA arrived unannounced and met with Program director Janelly Reyes and explained the purpose of today’s visit. The facility is licensed to serve 16 Ambulatory clients. Note: this is a short-term crisis residential program.

This is a 2-story facility located in an industrial area in Downey, Ca. A tour of the facility includes: First Floor: 2 client bedrooms, janitor closet, staff restroom, living room, nurse station, 2 restrooms, 1 shower room, medication room, multi-purpose room, dining room, kitchen, assessment room, storage room (with emergency food supply), program director office, laundry room, control panel room, and an intake room with restroom/shower. Second floor: 6 client bedrooms, administrators office, 3 shower rooms, 3 restrooms, laundry room, clinician station, staff restroom, and janitor closet.

LPA toured the facility and the following was observed: a total of 13 clients were at the facility during the visit. The program site is clean, safe. All passageways are free from obstruction. Disinfectants, cleaning solutions and poisons are inaccessible to clients and are locked inside kitchen area. There are multiple fire extinguishers throughout the facility. All the fire extinguishers are fully charged. Facility has a sprinkler fire system throughout the facility. There are carbon monoxides in each bedroom and throughout the facility. LPA’s toured random bedrooms, and each have the required bedding and furniture. The bathrooms were observed to be clean. The water temperature was tested in bathrooms and are not within the required 105-120 degrees F. Two (2) showers upstairs had a reading of 101 and 102.2. LPA observed one (1) shower upstairs to have a broken shower head. The program maintains a comfortable temperature in each room. The First Aid kit is kept in the kitchen and med room. The kitchen was observed for the ability to prepare and serve food. Facility has a food waiver on file where facility receives three daily deliveries. Sharps are kept locked in drawer in kitchen. The last fire drill/earthquake drill was conducted in August of 2025.

NAME OF LICENSING PROGRAM MANAGER: David Sicairos
NAME OF LICENSING PROGRAM ANALYST: Christian Gutierrez
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 09/09/2025

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/09/2025

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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Document Has Been Signed on 09/09/2025 12:25 PM - It Cannot Be Edited

Created By: Christian Gutierrez On 09/09/2025 at 12:00 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: CENTRAL STAR RANCHO LOS AMIGOS CRISIS RESIDENTIAL	FACILITY NUMBER: 198603569
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 09/09/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

81087(a)

Buildings and Grounds

(a) The facility shall be clean, safe, sanitary and in good repair at all times for the safety and well-being of clients, employees and visitors. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation, the licensee did not comply with the section cited above one bathroom upstairs had a broken shower head which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 09/23/2025
	Plan of Correction
1 2 3 4	Facility will replace shower head and send LPA pictures as proof.

Type B

Section Cited

CCR

81088(e)(1)

Fixtures, Furniture, Equipment, and Supplies

(e) Faucets used by clients for personal care such as shaving and grooming shall deliver hot water. (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
1 2 3 4	Based on observation, the licensee did not comply with the section cited above two (2) showers upstairs had a reading of 100 and 102.2 not withen the required rangewhich poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 09/16/2025
	Plan of Correction
1 2 3 4	Facility will adjust shower temperature and create water log for one week and send to LPA by POC due date.

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:

	Christian Gutierrez
NAME OF LICENSING PROGRAM ANALYST:

LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 09/09/2025

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/09/2025

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: CENTRAL STAR RANCHO LOS AMIGOS CRISIS RESIDENTIAL	FACILITY NUMBER: 198603569
	VISIT DATE: 09/09/2025

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LPA's reviewed medication for 4 clients and observed that medications are documented properly and given as prescribed. LPA reviewed five staff files that included criminal record clearance, current first aid and CPR, and ongoing training. Staff files are maintained at the facility and kept in the program director’s office. LPA reviewed 5 staff records. S4 was missing TB clearance. LPA reviewed five (5) Client files that kept electronically secured and have the following documents in their files - Admission Agreements, Identification & Emergency Information, current Physician's Report, Pre-admission appraisal/Appraisal Needs & Services Plan. Two staff and two clients interviewed.

Per California Code of Regulations, Title 22, and California Health and Safety Code, the deficiencies observed during the visit are documented on the LIC809Ds. Exit interview held and a copy of the report along with appeal rights were provided.

NAME OF LICENSING PROGRAM MANAGER: David Sicairos
NAME OF LICENSING PROGRAM ANALYST: Christian Gutierrez
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 09/09/2025

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/09/2025

LIC809 (FAS) - (06/04)

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