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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306003705
Report Date: 07/02/2026
Date Signed: 07/02/2026 12:16:30 PM

Document Has Been Signed on 07/02/2026 12:16 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:COACHMAN HOMEFACILITY NUMBER:
306003705
ADMINISTRATOR/
DIRECTOR:		RAFAEL TORRESFACILITY TYPE:
735
ADDRESS:9333 COACHMAN AVENUETELEPHONE:
(310) 567-9285
CITY:WHITTIERSTATE: CAZIP CODE:
90605
CAPACITY: 6CENSUS: 3DATE:
07/02/2026
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:36 AM
MET WITH:Alternate Administrator Jacqueline MikinTIME VISIT/
INSPECTION COMPLETED:
12:30 PM
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Licensing Program Analyst (LPA) Kimberly Ramirez conducted an unannounced Annual Required Visit on 07/02/2026. LPA Ramirez was met by Alternate Administrator Jacqueline Mikin and explained the purpose of the visit. The facility is licensed to serve six (6) ambulatory Developmentally Disabled clients who are ages 18-59. All clients residing at this home receive case management services provided by East Los Angeles Regional Center. Two (2) out of the three (3) clients in care are over the age of 59. The facility has an aged-over exemption that was approved in 2025. This facility maintains four (4) bedrooms and 1 ½ bathrooms.

Infection Control- Staff are using appropriate hand hygiene and wearing gloves while assisting clients. Staff are cleaning and disinfecting often for high touched surfaces. Facility has an Infection Control Plan in place.

Physical Plant & Environmental Safety- Disinfectants, cleaning solutions, poisons and other items that could pose a danger if readily available to clients, were observed to be inaccessible to clients. LPA Ramirez observed carbon monoxide detectors and smoke alarms in hallways. LPA Ramirez inspected three (3) shared client rooms. One (1) client bedroom was observed to be unoccupied during LPA’s inspection. LPA observed one (1) bedroom for live in staff. All client bedrooms contained the required furniture, linens and lighting. Water temperatures in all grooming and bathing areas were measured to be with 105 – 120 degrees.

Operational Requirements- Fire clearance is approved for six (6) ambulatory only clients. Licensee provides care and supervision according to the clients’ needs. LPA Ramirez obtained a copy of facility liability insurance and surety bond. Licensee manages clients’ cash resources.

SEE 809-C

NAME OF LICENSING PROGRAM MANAGER: Fernando Fierros
NAME OF LICENSING PROGRAM ANALYST: Kimberly Ramirez
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 07/02/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/02/2026
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: COACHMAN HOME
FACILITY NUMBER: 306003705
VISIT DATE: 07/02/2026
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Staffing- Administrator Certificate for Rafael Torres expires 04/23/2028 was observed. Alternate Administrator certificate for Jacqueline Mikin expires on 11/28/2026. Staff employed are over the age of 18 and are fingerprint cleared and associated to the facility. One (1) staff are on duty from at least 10pm to 6am to provide nighttime supervision.

Personnel Records-Training- Staff files are maintained at the facility. LPA Ramirez observed training, CPR and First Aid for three (3) out of the three (3) personnel record reviewed. LPA Ramirez observed TB testing results, Health screening, fingerprint clearance and job application for one (1) out of the one (1) personnel record reviewed. Administrator’s Bi-annual training on HIV and TB was reviewed. During personnel record review, LPA Ramirez observed annual training on care and supervision for clients 60 years of age or older. The facility currently provides care and supervision for five (5) residents aged 60 and older.

Clients Rights-Information- The facility has internet services and can provide internet access on a phone for clients to use.

Food Service- LPA Ramirez observed sufficient supply of nonperishables for one week and perishable foods for a minimum of two days in the facility kitchen area. Soaps, detergents, and cleaning compounds were observed to be stored away from food supplies. Freezers and refrigerators were observed to be clean and within temperatures of 0-degree F (-17.7 degree C), and refrigerators with maximum temperature of 40-degree F. (4 degree C).

Client Records-Incident Reports- LPA Ramirez observed original admissions agreements in client records. LPA Ramirez observed Individual Program Plan (IPP), Needs and Services and Functional Capabilities Assessment. LPA Ramirez observed current medication record orders and incident reports regarding clients’ health and safety. LPA Ramirez reviewed three (3) client records.

Health Related Services- The medications are centrally stored in the medication kitchen cabinet and in bubble packs and/or original containers. The facility provides incidental medical services.

Incidental Medical Services- There are zero (0) clients currently with Restricted Health conditions residing at the facility.

Disaster Preparedness- The facility has the Emergency Disaster Plan (LIC610D/9 pages) in place. Last documented emergency drills were conducted on 04/17/2026. LPA Ramirez observed emergency food supply located in attached garage.

Exit interview was conducted. No deficiencies were cited during this annual inspection.

Emergency Intervention- Per Administrator Rivas, the facility does not use manual restraints or seclusion rooms. Staff will use redirection when clients become agitated and contact the client’s doctor for further instructions.

Exit interview conducted. No deficiencies were observed. A copy of this report was provided.

NAME OF LICENSING PROGRAM MANAGER: Fernando Fierros
NAME OF LICENSING PROGRAM ANALYST: Kimberly Ramirez
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 07/02/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/02/2026
LIC809 (FAS) - (06/04)
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