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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306004467
Report Date: 02/13/2025
Date Signed: 02/13/2025 11:58:39 AM

Document Has Been Signed on 02/13/2025 11:58 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:CASA GARCIA LLCFACILITY NUMBER:
306004467
ADMINISTRATOR/
DIRECTOR:
KARINA SOTOFACILITY TYPE:
735
ADDRESS:13532 TRUMBALLTELEPHONE:
(562) 944-8545
CITY:WHITTIERSTATE: CAZIP CODE:
90605
CAPACITY: 5CENSUS: 5DATE:
02/13/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:17 AM
MET WITH:Russel Johnsrud- AdministratorTIME VISIT/
INSPECTION COMPLETED:
11:40 AM
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Licensing Program Analyst (LPA) S Vaid made an unannounced visit to Casa Garcia LLC. The purpose of today’s visit was to conduct the required Inspection. On today’s visit LPA met with Administrator, Russell Johnsrud. The home has 5 residents, 2 non-ambulatory, and 3 ambulatory, and two residents have a restricted health care condition. The facility conducted a fire drill on 01/04/25 and earthquake drill on 02/03/25.

As a part of the inspection, LPA reviewed (5) client records, (5) staff files, and (5) client medications. Facility is a one-story family home with five (5) bedrooms. Each bedroom is for one (1) client. There are (2) bathroom(s) for client use. There is also a living room, a kitchen/dining area, central air and heating, a shaded area located in the backyard. A detached car garage inaccessible to clients. Front and back yard is in good condition at time of visit, due to rain LPA observed yard areas. Washer/Dryer appliances observed in operation. Toxins and sharps locked and inaccessible to clients. Bedrooms #1-#5 are equipped with a (1) bed each, dresser, lamp, chair, sufficient lightning for each client. The facility has 2 bathrooms which have a working toilet, wash basin, and shower. Beds have the required linen/supplies which include, pillowcase, mattress padding, fitted sheet, blanket and bedspreads. Supply of hygiene supplies were observed. Fire alarms are interconnected and operational. Required postings observed. Water temperature measured in kitchen and 2 bathrooms are within required tittle 22 regulations. Interviewed 3 clients and 4 staff. One client is at day program and one client is at physicians’ appointment.

No deficiencies cited. An exit interview was conducted, and a copy of this report was provided to Administrator, Russell Johnsrud.
SUPERVISORS NAME: Fernando Fierros
LICENSING EVALUATOR NAME: Sanjay Vaid
LICENSING EVALUATOR SIGNATURE: DATE: 02/13/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/13/2025
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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