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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198603784
Report Date: 12/02/2025
Date Signed: 12/02/2025 01:02:37 PM

Document Has Been Signed on 12/02/2025 01:02 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:C-H ADULT DAY CENTER PROGRAM #2FACILITY NUMBER:
198603784
ADMINISTRATOR/
DIRECTOR:		HARTWELL, MAXINEFACILITY TYPE:
775
ADDRESS:15744 CALIFORNIA AVETELEPHONE:
(562) 630-8123
CITY:PARAMOUNTSTATE: CAZIP CODE:
90723
CAPACITY: 30CENSUS: 24DATE:
12/02/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:20 AM
MET WITH:Ernesto Ramos, StaffTIME VISIT/
INSPECTION COMPLETED:
01:10 PM
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Licensing Program Analyst (LPA) Daniel Konishi conducted an unannounced visit for an Annual Inspection. LPA met with the Staff, Ernesto Ramos, who assisted with the visit, and LPA explained the purpose for the visit. Administrator, Maxine Hartwell arrived shortly after and LPA explained the purpose of the visit. This facility is licensed as an Adult Day Care facility to serve thirty (30) clients, of which six (6) may be non-ambulatory.

LPA utilized the Compliance and Regulatory Enforcement (CARE) tools for the visit today and observed the following:



Infection Control: The facility staff are using appropriate hand hygiene and cleaning/disinfecting throughout the day. Facility has sufficient PPE supplies. Based on record review, LPA observed that the facility has an Infection Control Plan in place.

Physical Plant & Environment Safety: This is a single-story facility located in Paramount, CA. A tour of the facility includes: reception area, two (2) rooms by the front area which will be used for meetings and for rest, a large activity room, storage room, kitchen, and two (2) restrooms. Facility walls and floors were in good condition and adequate lighting. Smoke detectors and carbon monoxide detectors are operable and working properly. There are two (2) fire extinguishers that are fully charged and last inspected on 02/25/2025. No bodies of water were observed at the facility. All toilets and hand washing facilities were well maintained, safe, sanitary and in operating condition. LPA tested the hot water temperature throughout the facility restrooms and LPA measured in bathroom #1 at 114.8 and bathroom #2 at 112.2 degrees F which are within Title 22 Regulations of 105 degrees F to 120 degrees F.
NAME OF LICENSING PROGRAM MANAGER: David Sicairos
NAME OF LICENSING PROGRAM ANALYST: Daniel Konishi
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 12/02/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/02/2025
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
MONTEREY PARK ASC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754
FACILITY NAME: C-H ADULT DAY CENTER PROGRAM #2
FACILITY NUMBER: 198603784
VISIT DATE: 12/02/2025
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Incidental Medical & Dental: Staff have proper training and training is documented within the personnel files. Per Staff #1 (S1), there are no clients who have a restricted health condition.

Disaster Preparedness: The facility has an Emergency Disaster Plan with contact numbers and at least two (2) relocation sites. Evacuation Procedures are in the facility’s Health and Safety file. The last Fire Drill was conducted on 08/18/2025.

Emergency Intervention: The Facility does not use any restraints or seclusion on clients. Clients at this facility do not require the use de-escalation techniques.

Per California Code of Regulations, Title 22, and California Health and Safety Code, no deficiencies observed during today’s visit. Exit interview was held and a copy of the report and appeal rights were provided to the Staff, Ernesto Ramos.
NAME OF LICENSING PROGRAM MANAGER: David Sicairos
NAME OF LICENSING PROGRAM ANALYST: Daniel Konishi
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 12/02/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/02/2025
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: C-H ADULT DAY CENTER PROGRAM #2
FACILITY NUMBER: 198603784
VISIT DATE: 12/02/2025
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Physical Plant & Environment Safety [Cont.]: All storage areas for cleaning solutions, toxins, poisons and hazardous items are stored in a secured/locked storage room and inaccessible to clients.

Operational Requirements: The facility has the appropriate fire clearance. Staff are knowledgeable on their reporting requirements.

Staffing: There appears to be sufficient staffing in the facility. There are at least nine (9) staff members on duty any time there are clients in the facility. Per Staff #1 (S1), the staff to client ratio is one (1) caregiver to three (3) consumers.

Personnel Records-Training: LPA reviewed five (5) staff files that include Personnel Record, Health Screening, TB clearance, Employee Rights, Valid First Aid/AED/CPR Training, valid CPI Training, and Staff training. The Administrator’s Certificate is valid and expires on 01/09/2026.

Client Records-Incident Reports: Client files are kept in a secure location within the staff office and LPA reviewed five (5) client files which includes the face sheet, Identification and Emergency Information, Admission Agreement, Personal Rights, Physician's Report, Ambulatory Status, TB clearance, and a current Behavior Intervention Plan Assessment.

Client Rights-Information: Client Rights Poster is posted within the large activity room.
Per Staff #1 (S1), there are no clients with postural supports.

Food Service: Refrigerators are available for client use to store their lunches. The program does not provide lunch. The kitchen has no stove. Pesticides and other similar toxic substances are not stored in food storage rooms or other kitchen areas.

Health Related Services: LPA reviewed one (1) client medication. Medications are administered as prescribed. Medications are centrally stored and locked. Facility staff have an updated first aid certificate and they have at least one staff able to perform CPR. LPA observed the First Aid Kit which had all required items.
NAME OF LICENSING PROGRAM MANAGER: David Sicairos
NAME OF LICENSING PROGRAM ANALYST: Daniel Konishi
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 12/02/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/02/2025
LIC809 (FAS) - (06/04)
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