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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306006192
Report Date: 01/31/2025
Date Signed: 01/31/2025 11:13:14 AM

Document Has Been Signed on 01/31/2025 11:13 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
CCLD Regional Office, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME:VIOLA HOMES ESTATEFACILITY NUMBER:
306006192
ADMINISTRATOR/
DIRECTOR:		SNETTER, MIATTAFACILITY TYPE:
735
ADDRESS:15770 AZALEA WAYTELEPHONE:
(323) 304-4620
CITY:WESTMINSTERSTATE: CAZIP CODE:
92683
CAPACITY: 4CENSUS: 4DATE:
01/31/2025
TYPE OF VISIT:Case Management - Health ChecksUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:30 AM
MET WITH:Hailey CamachoTIME VISIT/
INSPECTION COMPLETED:
11:30 AM
NARRATIVE
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Licensing Program Analyst (LPA) Claudia Gutierrez made an unannounced case management visit for the purpose of conducting health and safety checks at the facility. LPA met with Staff Hailey Camacho and explained the purpose of the inspection.

LPA and Staff Camacho conducted a tour of the inside and outside of the facility. The facility is a single story home with four client bedrooms, two bathrooms, and attached two car garage. LPA observed all client bedrooms had the required furnishings. LPA observed all client beds had linens and blankets. Water temperature in client bathrooms tested between 126.6-130.4 degrees Fahrenheit; a deficiency was cited on this date. Faucets and toilets were operational, however, one of two bathroom sinks was observed to be clogged. LPA also observed microwave to be non-operational and a mold covered bread was observed to be decaying in a plastic container being stored in a kitchen cabinet; a Deficiency was cited on today's date. LPA observed the facility has a 2-day supply of perishables, however a 7-day supply of non-perishable food as required by regulations was not observed; a Deficiency was cited on today's date. Smoke detectors and carbon monoxide detectors tested operational. Sharp items and knives were observed to be inaccessible to clients. Fire extinguisher was observed to be fully charged with service tag dated March 13, 2024. Facility has a shaded seating area in the front entrance of the home and no obstacles or hazards were observed.

Based on observations made during today’s inspection, deficiencies are being cited per Title 22 Division 6 of the California Code of Regulations.

An exit interview was conducted and a copy of this report and appeal rights was provided to the facility.

SUPERVISORS NAME: Armando J Lucero
LICENSING EVALUATOR NAME: Claudia Gutierrez
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)
Page: 1 of 3
Document Has Been Signed on 01/31/2025 11:13 AM - It Cannot Be Edited


Created By: Claudia Gutierrez On 01/31/2025 at 10:36 AM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868

FACILITY NAME: VIOLA HOMES ESTATE
FACILITY NUMBER: 306006192

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/31/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
02/28/2025
Section Cited
CCR
80088(e)(1)

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(1) Hot water temperature controls shall be maintained to automatically regulate temperature... delivered to plumbing fixtures used by clients to attain a hot water temperature of not less than 105 degrees F... and not more than 120 degrees F...
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Staff Camacho stated water temperature will be adjusted to meet regulation requirement and a water temperature log maintained to ensure consistancy and a copy provided to LPA via email by POC date.
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This requirement is not met as evidenced by:

Based on observation the licensee did not comply with the section cited above as hot water temperature tested between 126.6-130.4 degrees F, which poses a potential safety risk to persons in care.
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Type B
02/28/2025
Section Cited
CCR80087(a)

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(a) The facility shall be clean, safe, sanitary and in good repair at all times for the safety and well-being of clients, employees and visitors.

This requirement is not met as evidenced by:
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Staff Camacho immediately discarded of mold covered bread and container, and stated the bathroom sink and microwave will be repaired and proof provided to LPA via email by POC date.
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Based on observation the licensee did not comply with the section cited above as bathroom sink was observed to be clogged, microwave was non-operational and a mold covered bread was kept in a plastic container, which poses a potential personal rights and safety risk to persons in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Armando J Lucero
LICENSING EVALUATOR NAME:Claudia Gutierrez
LICENSING EVALUATOR SIGNATURE:
DATE: 01/31/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/31/2025


LIC809 (FAS) - (06/04)
Page: 2 of 3
Document Has Been Signed on 01/31/2025 11:13 AM - It Cannot Be Edited


Created By: Claudia Gutierrez On 01/31/2025 at 10:57 AM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868

FACILITY NAME: VIOLA HOMES ESTATE
FACILITY NUMBER: 306006192

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/31/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
02/28/2025
Section Cited
CCR
85076(d)(1)

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(1) Supplies of staple nonperishable foods for a minimum of one week and fresh perishable foods for a minimum of two days shall be maintained on the premises.

This requirement is not met as evidenced by:
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Staff Camacho stated a 7-day supply of perishable foods will be purchased and maintained and proof provided to LPA via email by POC date.
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Based on observation the licensee did not comply with the section cited above as a 7-day suplly of non-perishable food was not observed, which poses a potential health and personal rights risk to persons in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Armando J Lucero
LICENSING EVALUATOR NAME:Claudia Gutierrez
LICENSING EVALUATOR SIGNATURE:
DATE: 01/31/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/31/2025


LIC809 (FAS) - (06/04)
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