198603677-1-15-2026-28-AS-EMAT-DQCV8B-20260115151229

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 198603677
Report Date: 01/15/2026
Date Signed: 01/15/2026 03:14:09 PM

Document Has Been Signed on 01/15/2026 03:14 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:	NEW HAVEN RESIDENTIAL LLC		FACILITY NUMBER:	198603677
ADMINISTRATOR/ DIRECTOR:	NWADIKE, VIOLA		FACILITY TYPE:	775
ADDRESS:	12510 E. SLAUSON AVE UNIT I&H		TELEPHONE:	(818) 274-1809
CITY:	SANTA FE SPRINGS	STATE: CA	ZIP CODE:	90670
CAPACITY: 90		CENSUS: 36	DATE:	01/15/2026
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	08:05 AM
MET WITH:	Program Director- Viola Nwadike		TIME VISIT/ INSPECTION COMPLETED:	03:15 PM

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25

Licensing Program Analysts (LPAs) Elena Mallett and Bonnie Tao conducted an unannounced Annual visit and was met by Supervisor Cindy Alvarenga. The purpose of the visit was explained . Administrator Viola Nwadike joined the visit shortly after. This is an Adult Day Program to serve 60 ambulatory and 30 non-ambulatory clients. The census today was 36 clients in care. Clients are served from East Los Angeles, South Central Los Angeles and Harbor Regional Centers.

The program consists of one (1) large single-story building. A tour of the single-story building included: reception area, four (4) offices, two (2) client and one(1) staff restrooms, one (1) isolation room, one(1) relaxation room, area where snack was prepared and lunches stored, two(2) activity rooms, conference room and a locked storage room. LPA toured the facility and the following was observed: a total of 36 clients were at the facility.

LPA completed the visit using the following inspection tool domains:

Infection Control: Infection Control Plan was reviewed by LPA. Plan follows title 22 regulations. Per Administrator plan is adhered to by all staff.

Physical Plant and Environmental Safety: Physical plant is in clean and good condition. Hallways and rooms are free from debris and obstruction. The restrooms were observed to be clean and have the required grab bars to support client needs. The activity rooms had adequate space for their function and to store needed activity materials. Clients were observed engaging with staff in activities, such as arts and crafts and movement with music. Many clients left for community outings part way through visit. Fire and CO2 detectors were tested and operational. Cleaners, toxins and sharps are in locked cabinets inaccessible to clients. There were 5 Fire extinguishers that were fully charged. Hot water temperature measured in the two client restrooms was not within Title 22 regulations. A deficiency was cited. See 809-D.

NAME OF LICENSING PROGRAM MANAGER: Fernando Fierros
NAME OF LICENSING PROGRAM ANALYST: Elena Mallett
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 01/15/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/15/2026

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)

Page: 1 of 4

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)

Page: 2 of 4

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: NEW HAVEN RESIDENTIAL LLC	FACILITY NUMBER: 198603677
	VISIT DATE: 01/15/2026

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

Operational Requirements: Facility has a fire clearance. Staff was observed in 1:3 ratios with clients per Regional Center regulations. Facility has a Plan of Operation. Carbon monoxide detector and smoke detectors are monitored by Security Concepts Inc.

Personal Records - Training: Locked storage space for staff files was observed. Five (5) Staff files were reviewed and no issues were observed. All had required, current training and health screening with TB test.Program Director Nwadike passed ARF Administrator exam on 05/23/2024.

Client Records : Locked Storage space for client files observed. Five (5) client files were reviewed and no issues were observed.

Client Rights - Information: Required postings present.

Food Service: Day program serves snack. Clients bring lunch from home and can store them in an operable refrigerator or cabinet. There is a microwave to heat food. Snack is provided to everyone. Snack food was properly stored away from any cleaners or toxins.

Health Related Services: Fully stocked First Aid kit and Manual present. Facility does not contain an AED. Facility does not assist clients with their medication.

Disaster Preparedness: Facility has emergency disaster plan in place. The disaster plan includes at least 2 relocation places and has plan in place for clients. Disaster drills are conducted quarterly. Last drill was conducted on 12 /25. Disaster food and water supply was present.

Administrator will follow up with Guardian with regards to Staff 6 and provide update to LPA Mallett.

Per Title 22 a deficiency was cited today. An exit interview was conducted with Program Director Nwadike and copy of this Licensing Report and Appeal rights were provided.

NAME OF LICENSING PROGRAM MANAGER: Fernando Fierros
NAME OF LICENSING PROGRAM ANALYST: Elena Mallett
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 01/15/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/15/2026

LIC809 (FAS) - (06/04)

Page: 3 of 4

Document Has Been Signed on 01/16/2026 01:56 PM - It Cannot Be Edited

Document is an Amendment of Original Document on 01/16/2026 01:49 PM

Created By: Elena Mallett On 01/15/2026 at 02:44 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
MONTEREY PARK ASC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754

FACILITY NAME: NEW HAVEN RESIDENTIAL LLC	FACILITY NUMBER: 198603677
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 01/15/2026

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

82088(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 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 in 3 out of 3 water temperture tests in restroom sinks were below Title 22 requirements ( 99 F,98 F and 103F) , which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 01/22/2026
	Plan of Correction
1 2 3 4	By POC due date Licensee agreed to raise the water temperture in all restroom sinks to a range of 105F-120F and will keep a water log of temperture on weekly basis in the future. POC was cleared during today's visit.

Section Cited


	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

	Fernando Fierros
NAME OF LICENSING PROGRAM MANAGER:

	Elena Mallett
NAME OF LICENSING PROGRAM ANALYST:

LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 01/15/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/15/2026

LIC809 (FAS) - (06/04)

Page: 4 of 4