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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306004467
Report Date: 10/10/2025
Date Signed: 10/10/2025 11:16:27 AM

Document Has Been Signed on 10/10/2025 11:16 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:		MARIANO PRIETOFACILITY TYPE:
735
ADDRESS:13532 TRUMBALLTELEPHONE:
(562) 944-8545
CITY:WHITTIERSTATE: CAZIP CODE:
90605
CAPACITY: 5CENSUS: 5DATE:
10/10/2025
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:25 AM
MET WITH:Administrator Mariano PrietoTIME VISIT/
INSPECTION COMPLETED:
11:30 AM
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Licensing Program Analyst (LPA) Kimberly Ramirez and LPA Elena Mallett conducted an unannounced Case Management Visit-Incident on 10/09/2025, stemming from incident report received on 09/08/2025. LPAs were greeted by House Manager Joseph Santoyo and explained the purpose of the visit. Administrator Mariano Prieto arrived shortly after to assist.

Case Management findings:

On 09/08/2025, LPA Ramirez received a Vendor Incident Report dated 09/06/2025, regarding Client#1 (C1). According to this report on 09/06/2025 at 6:15am, staff went into C1’s room to wake C1 for a shower. Staff noticed there was vomit in C1’s bed and C1 appeared to be sluggish. Staff immediately called 911 and notified the facility administrator about the incident. C1 was transported to a local hospital emergency room. C1 was treated for alcohol intoxication and released back to the facility with no new orders. Staff and attending hospital doctor discussed that with C1’s prior history of Pica, C1 may have ingested a household item such as rubbing alcohol, hand sanitizer or mouth wash, which could have caused the alcohol intoxication. Administrator Prieto directed staff to inspect C1’s room and the facility for the item or items that could have attributed to C1’s alcohol intoxication. Staff searched the entire facility and did not find alcohol in C1’s room or in any accessible cabinet but staff did find a bottle of mouth wash that should have been full; was now 1/5 lower than expected. According to the incident report, the hygiene cabinet was accessible and unlocked due to HCBS inspection recommendations. Staff immediately locked the hygiene cabinet after the incident.

see 809-C

NAME OF LICENSING PROGRAM MANAGER: Fernando Fierros
NAME OF LICENSING PROGRAM ANALYST: Kimberly Ramirez
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 10/10/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/10/2025
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: CASA GARCIA LLC
FACILITY NUMBER: 306004467
VISIT DATE: 10/10/2025
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On 10/10/2025, LPA Ramirez reviewed C1’s records which revealed C1 has been at the facility since 08/24/2011. C1 has a history of Pica and has a history of picking up cigarette buds off the floor. Records reviewed revealed that C1’s Pica is being monitored and there was no documentation of C1 attempting or ingesting mouth wash or other liquids. Eastern Los Angeles Regional Center Semi-Annual Review conducted on 08/20/2025, did not find any deficiencies or substantial inadequacies. Interviews conducted revealed that immediately after the incident, staff locked up all hygiene products and will continue to keep hygiene products inaccessible to all clients. Interview with Administrator Mariano Prieto revealed the facility will be updating C1’s needs and services plan and discussing the incident on C1’s next semi-annual individual service plan (ISP) taking place in 11/2025.

No deficiencies were cited during this case management visit. 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: 10/10/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/10/2025
LIC809 (FAS) - (06/04)
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