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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198603820
Report Date: 01/31/2025
Date Signed: 01/31/2025 11:25:57 AM

Document Has Been Signed on 01/31/2025 11:25 AM - 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:PEOPLE'S CARE SAN ANGELO EBSHFACILITY NUMBER:
198603820
ADMINISTRATOR/
DIRECTOR:		MORA, HUENDYFACILITY TYPE:
737
ADDRESS:308 S SAN ANGELO AVETELEPHONE:
(909) 287-3557
CITY:LA PUENTESTATE: CAZIP CODE:
91746
CAPACITY: 3CENSUS: 3DATE:
01/31/2025
TYPE OF VISIT:PrelicensingANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:30 AM
MET WITH:Sharon Han, LicenseeTIME VISIT/
INSPECTION COMPLETED:
11:30 AM
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Licensing Program Analysts (LPAs) Luis De Leon and Nune Margaryan conducted an announced visit to the facility for the purpose of pre-licensing evaluation. The CARE Tool was using during initial inspection. Present for the pre-licensing inspection were Sharon Han (licensee), Huendy Mora (Administrator), Lee Strollo (District Manager) and Jessica Rodriguez (Assistant Administrator). An application was submitted to CCLD on 9/25/24, for initial license for Adult Residential Facility- for Enhanced Behavioral Supports Home. The new license request is a result of a change of ownership application. The facility has an approved fire clearance for three (3) non-ambulatory clients and facility approved for total capacity of three (3).

This is a one-story home located in a residential neighborhood area which will be licensed as an Adult Residential Facility for Enhanced Behavioral Supports Home. The facility was toured. The following was observed:
  • Three (3) client bedrooms, two (2) bathrooms, living room, dining area, kitchen, office room, activity/therapy room, and an attached garage. Client bedrooms were checked. Each bedroom is equipped with the proper furnishings. Bedrooms also have sufficient closet space. Bathrooms are clean and have the required hygiene items.
  • Laundry room was located on the end of the kitchen.
  • The front and backyard are well maintained and there are no pools or large bodies of water.
  • There is a shaded seating area for the clients located in the backyard.
  • Hallways and exits are free of obstruction.
  • There is only one entrance being utilized at the facility.
  • All required posters were posted at the entrance.
  • There is sufficient perishable and non-perishable food.

See LIC-809C for continuation of report.

SUPERVISORS NAME: Fernando Fierros
LICENSING EVALUATOR NAME: Luis DeLeon
LICENSING EVALUATOR SIGNATURE: DATE: 01/31/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/31/2025
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: PEOPLE'S CARE SAN ANGELO EBSH
FACILITY NUMBER: 198603820
VISIT DATE: 01/31/2025
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  • All the appliances are clean and working properly.
  • Sharps are locked in the office and are inaccessible to clients.
  • The fire extinguishers (2) observed to be fully charged, last check 11/24. Smoke/carbon monoxide detectors observed to be fully operational.
  • LPAs observed the centrally stored medications locked in the office and inaccessible to clients. The first aid kit was observed and found to be following the Title 22 Regulations.
  • LPAs reviewed client’s files and observed that all files are updated. LPAs confirmed staff working have fingerprint clearances.

LPA conducted the Component III with licensee and administrator. The Pre-licensing is complete, and the facility has no deficiencies.

An exit interview was conducted, and a copy of this report has been furnished to the applicant. Accordingly, LPAs will submit a copy of this facility evaluation report to the Central Applications Bureau (CAB) for review. If the applicant has questions regarding the status of the application, they have been instructed to communicate with the CAB Analyst assigned to their application.
SUPERVISORS NAME: Fernando Fierros
LICENSING EVALUATOR NAME: Luis DeLeon
LICENSING EVALUATOR SIGNATURE:

DATE: 01/31/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/31/2025
LIC809 (FAS) - (06/04)
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