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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 191593145
Report Date: 01/19/2023
Date Signed: 01/19/2023 04:40:45 PM


Document Has Been Signed on 01/19/2023 04:40 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
CCLD Regional Office, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754



FACILITY NAME:RAMONA GUEST HOME - BELLFLOWERFACILITY NUMBER:
191593145
ADMINISTRATOR:KANIEL, STANLEYFACILITY TYPE:
735
ADDRESS:9555 RAMONA STTELEPHONE:
(562) 867-1002
CITY:BELLFLOWERSTATE: CAZIP CODE:
90706
CAPACITY:29CENSUS: 24DATE:
01/19/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:25 AM
MET WITH:Administrator Stanley Kaniel TIME COMPLETED:
05:00 PM
NARRATIVE
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On 01/19/23, at 9:25 a.m., Licensing Program Analyst (LPA) Jewel Baptiste and Licensing Program Manager (LPM) Lisa Hicks conducted a required annual visit in conjunction with a subsequent complaint investigation. On today’s visit LPA and LPM met with administrator Stanley Kaniel who assisted with today’s visit.

The facility is licensed to serve 29 clients between the ages of 18 and 59 years old. The facility has 3 single buildings in a residential area, with 15 client Bedrooms, 2 live-in staff bedrooms, 9 bathrooms, kitchen, dining room, living room, and activities room. Fire extinguisher observed throughout the facility fully charged. There are smoke detectors located throughout the facility, tested and operational. Administrator stated the facility does not have carbon monoxide detectors.

LPA and LPM discussed infection control practices with administrator, toured the facility inside and out, reviewed food supply, resident files, and resident medications.

Upon arrival LPA and LPM observed 3 buildings and a small parking lot in the back of the second building. LPA noticed the second building had broken windows all around the building with a piece of wood and sheets covering parts of it. LPA also noticed there was debris located on the side of the second building and on the side of the third building. LPA was told by administrator, staff, and clients that they have between 5-7 homeless residents living on the premises and they do not want to leave.
Report continued 809c
SUPERVISOR'S NAME: Lisa HicksTELEPHONE: (323) 213-1556
LICENSING EVALUATOR NAME: Jewel BaptisteTELEPHONE: (323) 400-9594
LICENSING EVALUATOR SIGNATURE:
DATE: 01/19/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/19/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.

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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
CCLD Regional Office, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754
FACILITY NAME: RAMONA GUEST HOME - BELLFLOWER
FACILITY NUMBER: 191593145
VISIT DATE: 01/19/2023
NARRATIVE
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During the tour LPA and LPM observed 3 homeless squatters on the premises. According to the administrator they have contacted Lakewood Sheriffs Station for the past 1 1/2 approximately 50 times, and nothing has been done. The administrator also stated in 2021 they filed an unlawful trespassing document with the district attorney which have since expired. Administrator Stanley stated the problem started over a year ago with a client who allows the homeless population to enter. An eviction notice was given to the client in 2021 and 2022.

Bedrooms have the required furniture including bedframes, dressers, lamps, and chairs, but the blinds and closet doors were in disrepair in all bedrooms. The drawers in room # 1 were in disrepair, Room #2 client had a single mattress on the floor and roaches were observed. In room #12 the walls were cracked, Room #15 had broken tiles on the floor and room #14 had broken electrical sockets. LPA and LPM observed in client room #4 was filthy with garbage on the floor, and the bathroom was filthy and in disrepair. Room # 5 is being occupied by a homeless squatter, which was asked to leave and left the premises. Administrator expressed squatter will return later. LPA toured the kitchen and observed 7 days of perishables and 2 days nonperishable. During the tour of the kitchen LPA observed sharps unsecured without a designated locked area. The resident bathrooms were observed with dirt, stains, debris with broken flooring and window screens. LPA was unable to measure the hot water temperature due to malfunction of the thermometer. The facility temperature at the time of the visit was comfortable. LPA observed a sufficient supply of PPE. Medications reviewed for 5 clients, and LPA observed the facility does not keep proper document of medication given. LPA also observed the bubble pack medication is not administered in order. Facility file review revealed administrator certificate expired on 3/12/2022 and the facility do not have a plan of operation on file.



Pursuant to Title 22 code of regulations, the following deficiencies were cited (refer to LIC 809-D): Exit Interview Conducted with licensee / Appeal Rights Provided / A Copy of the Report Issued.
SUPERVISOR'S NAME: Lisa HicksTELEPHONE: (323) 213-1556
LICENSING EVALUATOR NAME: Jewel BaptisteTELEPHONE: (323) 400-9594
LICENSING EVALUATOR SIGNATURE:

DATE: 01/19/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/19/2023
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 01/19/2023 04:40 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754


FACILITY NAME: RAMONA GUEST HOME - BELLFLOWER
FACILITY NUMBER: 191593145

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/19/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
HSC
1503.2
General Provisions
Every facility licensed or certified pursuant to this chapter shall have one or more carbon monoxide detectors in the facility that meet the standards established in Chapter 8 (commencing with Section 13260) of Part 2 of Division 12. The department shall account for the presence of these detectors during inspections.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, the licensee did not comply with the section cited above, when the administrator confirmed the facility do not have carbon monoxide detectors, which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 01/20/2023
Plan of Correction
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The Administrator will send proof that the facility has a carbon monoxide detectors by POC due date. Email proof can be sent to LPA and LPM.
Type A
Section Cited
CCR
80087(g)
Building and Grounds
(g) Disinfectants, cleaning solutions, poisons, firearms and other items that could pose a danger if readily available to clients shall be stored where inaccessible to clients.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, the licensee did not comply with the section cited above when LPA observed knife on the sink and without a locked storage. which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 01/20/2023
Plan of Correction
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Administrator will ensure the facility has a locked storage for sharps by POC due date.
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: Lisa HicksTELEPHONE: (323) 213-1556
LICENSING EVALUATOR NAME: Jewel BaptisteTELEPHONE: (323) 400-9594
LICENSING EVALUATOR SIGNATURE:
DATE: 01/19/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/19/2023
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 01/19/2023 04:40 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754


FACILITY NAME: RAMONA GUEST HOME - BELLFLOWER
FACILITY NUMBER: 191593145

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/19/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
80072(a)(2)
Personal Rights
(a) Except for children's residential facilities, each client shall have personal rights which include, but are not limited to, the following: (2) To be accorded safe, healthful and comfortable accommodations, furnishings and equipment to meet his/her needs.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, the licensee did not comply with the section cited above in which the facility has allowed homesless squatters to move into the facility, which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 02/20/2023
Plan of Correction
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The administrator will remove all homeless squatters and will put in plan in place to keep squatters off the property by POC due date.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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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: Lisa HicksTELEPHONE: (323) 213-1556
LICENSING EVALUATOR NAME: Jewel BaptisteTELEPHONE: (323) 400-9594
LICENSING EVALUATOR SIGNATURE:
DATE: 01/19/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/19/2023
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 01/19/2023 04:40 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754


FACILITY NAME: RAMONA GUEST HOME - BELLFLOWER
FACILITY NUMBER: 191593145

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/19/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
80087(a)
Building and Grounds
(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:
Deficient Practice Statement
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Based on observation, the licensee did not comply with the section cited above in which the client in bedroom #2 has no bed, , bathroom tiles were in disrepair, Room #9 had a hole in the roof, All rooms had no curtain rods, All rooms had broken closet doors, and most rooms had broken furniture, which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 02/19/2023
Plan of Correction
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The licensee will repair all items by POC due due and send proof to LPA by POC due date.
Type B
Section Cited
CCR
80087(a)(1)
Building and Grounds
(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. (1) The licensee shall take measures to keep the facility free of flies and other insects.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation in room #2 LPA and LPM observed roaches, which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 02/19/2023
Plan of Correction
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The Licensee will remove all roaches and send proof to LPA by POC due date.
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: Lisa HicksTELEPHONE: (323) 213-1556
LICENSING EVALUATOR NAME: Jewel BaptisteTELEPHONE: (323) 400-9594
LICENSING EVALUATOR SIGNATURE:
DATE: 01/19/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/19/2023
LIC809 (FAS) - (06/04)
Page: 5 of 8


Document Has Been Signed on 01/19/2023 04:40 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754


FACILITY NAME: RAMONA GUEST HOME - BELLFLOWER
FACILITY NUMBER: 191593145

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/19/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
80022(a)
Plan of Operation
(a) Each licensee shall have and maintain on file a current, written, definitive plan of operation.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on interview, the licensee did not comply with the section cited above by not having a plan of operation for the facility, which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 02/19/2023
Plan of Correction
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The administrator will create a plan of operation and send to licensing by POC due date.
Type B
Section Cited
CCR
85064(b)
Administrator Qualifications and Duties
(b) All adult residential facilities shall have a qualified and currently certified administrator.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, the licensee did not comply with the section cited above. Administrator certificate expired 3/12/2022, which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 02/19/2023
Plan of Correction
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The administrator will renew certificate and send proof to LPA by POC due date.
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: Lisa HicksTELEPHONE: (323) 213-1556
LICENSING EVALUATOR NAME: Jewel BaptisteTELEPHONE: (323) 400-9594
LICENSING EVALUATOR SIGNATURE:
DATE: 01/19/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/19/2023
LIC809 (FAS) - (06/04)
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