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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198603613
Report Date: 02/25/2025
Date Signed: 02/25/2025 04:42:06 PM

Document Has Been Signed on 02/25/2025 04:42 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:STAR VIEW RANCHO LOS AMIGOS CRTFACILITY NUMBER:
198603613
ADMINISTRATOR/
DIRECTOR:		ELIZABETH WILSONFACILITY TYPE:
772
ADDRESS:7755 LEEDS STREETTELEPHONE:
(562) 719-2867
CITY:DOWNEYSTATE: CAZIP CODE:
90242
CAPACITY: 16CENSUS: 13DATE:
02/25/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:15 AM
MET WITH:Karla Portillo, Program DirectorTIME VISIT/
INSPECTION COMPLETED:
04:45 PM
NARRATIVE
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Licensing Program Analysts (LPAs), Mayra Cota, Noemi Galarza and Blanca Gonzalez, conducted an annual inspection today. LPAs met with Karla Portillo, Program Director, and explained the purpose of the visit. Maria Herrera, Quality Assurance Specialist, assisted with the tour of the facility.

The facility is a Social Rehabilitation Facility licensed to serve 16 ambulatory clients of which 2 may be non-ambulatory. The facility provides short-term crisis treatment to adult clients within the scope of its program. The two story building is in an industrial area of Downey. The tour of the facility consisted of the following:

First floor: lobby, visitor sign-in area, TV room/lounge, dining area, warming kitchen, linen room, two client bedrooms, janitor’s closet, trash enclosure, staff restroom #1, staff station, medication room, interview room, laundry room #1, intake hygiene room with client restroom #1/shower #1, director’s office, client restroom #2 and #3 and client shower #2.

Second floor: six client bedrooms, client restroom #4, 5 and 6, client showers #3, 4 and 5, staff lounge, employee patio, QA office, living room, linen/personal hygiene products storage room, elevator, laundry room #2, staff station, staff restroom #2 and water heater room.

Each client bedroom has the required furniture but 11 out of 13 beds did not have mattress pads. Six out of the eight client roll-down curtains were observed to be malfunctioning. There is extra clean linen and towels in the linen room on first and second floor. The intake/hygiene room lid-less trash bin had a used incontinence brief. The kitchen was observed for the ability to prepare and serve food. Dishwasher was observed to be non-operable and maintenance documentation indicated it has been out of order since 2/17/25. Dining area trash bins did not have tight-fighting lids and were observed to be filled with food items. Facility has a food waiver on file, where facility receives daily deliveries of three meals per client per day. Snacks were observed and are available for clients upon request. Sufficient emergency food supply was observed, labeled, and kept within expiration limits.

***Continues on LIC 809C

SUPERVISORS NAME: Wei Siew Ho
LICENSING EVALUATOR NAME: Mayra Cota
LICENSING EVALUATOR SIGNATURE: DATE: 02/25/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/25/2025
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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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: STAR VIEW RANCHO LOS AMIGOS CRT
FACILITY NUMBER: 198603613
VISIT DATE: 02/25/2025
NARRATIVE
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 The facility has a sprinkler fire system which operates on both floors. Facility is equipped with carbon monoxide detectors. There are four fire extinguishers throughout the building and observed to be charged. Cleaning supplies and toxic substances are inaccessible to clients and are locked in the janitor and water heater room. The First Aid kit is kept in the medication room and was observed to be fully stocked with all required items including a current manual. Medications are centrally stored and locked in the medication room. Medications are documented properly and given as prescribed. Client shared restrooms and showers were inspected but water temperature was not between the required range of 105-120 degrees F. Light fixtures missing in one client shower room and restroom. The outdoor environment was toured and was observed to have a shaded and seating area accessible to clients. There is a gardening area with stationary planters which are also accessible to clients. Outdoor walkways were clean and free of obstructions. The facility does not have a swimming pool or bodies of water on the premises.

Eight staff and 8 client files were reviewed during today's visit. Staff working at facility have fingerprint clearances. Last fire drill was conducted on 1/31/25.

Deficiencies are being cited. See LIC 809D.

Exit interview was conducted with Karla Portillo, Program Director. A copy of the report, appeal rights was issued.

SUPERVISORS NAME: Wei Siew Ho
LICENSING EVALUATOR NAME: Mayra Cota
LICENSING EVALUATOR SIGNATURE:

DATE: 02/25/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/25/2025
LIC809 (FAS) - (06/04)
Page: 2 of 5
Document Has Been Signed on 02/25/2025 04:42 PM - It Cannot Be Edited


Created By: Mayra Cota On 02/25/2025 at 03:26 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: STAR VIEW RANCHO LOS AMIGOS CRT
FACILITY NUMBER: 198603613

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/25/2025

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
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Based on observation, the licensee did not comply with the section cited above due to missing light fixtures in one client shower and one staff restroom, which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 03/11/2025
Plan of Correction
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Director agreed to replace missing light fixtures and provide LPA proof via photographs of the rooms in which the fixtures are missing.
Type B
Section Cited
CCR
81088(f)
Fixtures, Furniture, Equipment, and Supplies
(f) Solid waste shall be stored, located and disposed of in a manner that will not transmit communicable diseases or odors, pose a risk to health and safety, create a nuisance, or provide a breeding place or food source for insects or rodents.

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 two trashbins did not have the proper tigh-fitting covers, which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 03/11/2025
Plan of Correction
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Licensee agreed to send LPA proof of purchase receipts and photos of trashbins and lids.
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: 02/25/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/25/2025


LIC809 (FAS) - (06/04)
Page: 3 of 5
Document Has Been Signed on 02/25/2025 04:42 PM - It Cannot Be Edited


Created By: Mayra Cota On 02/25/2025 at 03:26 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: STAR VIEW RANCHO LOS AMIGOS CRT
FACILITY NUMBER: 198603613

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/25/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
81088(i)(4)
Fixtures, Furniture, Equipment, and Supplies
(i) The licensee shall ensure provision to each client of the following furniture, equipment and supplies necessary for personal care and maintenance of personal hygiene. (4) Clean linen in good repair, including lightweight, warm blankets and bedspreads; top and bottom bed sheets; pillow cases; mattress pads; rubber or plastic sheeting, when necessary; and bath towels, hand towels, and washcloths.

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 11 out of 13 clients mattresses, which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 03/11/2025
Plan of Correction
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Licensee agreed to purchase appropriate mattress pads for all client mattresses and provide LPA, proof of purchase receipts and photos of the client's mattress with the pads on.
Type B
Section Cited
CCR
81076(a)(19)
Food Service
(a) In a social rehabilitation facility providing meals to clients, the following shall apply: (19) All equipment, fixed or mobile, dishes, and utensils shall be kept clean and maintained in safe condition.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observations and record review, the licensee did not comply with the section cited above in that the facility's dishwasher was inoperable at the time of visit, which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 03/11/2025
Plan of Correction
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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.
SUPERVISOR'S NAME:Wei Siew Ho
LICENSING EVALUATOR NAME:Mayra Cota
LICENSING EVALUATOR SIGNATURE:
DATE: 02/25/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/25/2025


LIC809 (FAS) - (06/04)
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Document Has Been Signed on 02/25/2025 04:42 PM - It Cannot Be Edited


Created By: Mayra Cota On 02/25/2025 at 04:01 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: STAR VIEW RANCHO LOS AMIGOS CRT
FACILITY NUMBER: 198603613

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/25/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
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
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Based on observation, the licensee did not comply with the section cited above in that 5 out of 5 client restroom faucets did not deliver any hot water, which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 02/26/2025
Plan of Correction
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Licensee agreed to submit a plan of correction. Director will call maintenance and will submit a hot water temperature logged by each shift staff for today up until Friday, February 28, 2025.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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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.
SUPERVISOR'S NAME:Wei Siew Ho
LICENSING EVALUATOR NAME:Mayra Cota
LICENSING EVALUATOR SIGNATURE:
DATE: 02/25/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/25/2025


LIC809 (FAS) - (06/04)
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