Follow-up·September 25, 2025

On 09/25/2025, the California Department of Social Services (CDSS) – Community Care Licensing Division (CCLD) Licensing Program Analyst (LPA) Socorro Leandro conducted an unannounced case management visit to the above-named facility and met with Caregiver, Rosemarie Masancay. The purpose of the visit was explained and the LPA was allowed entry to the facility. This facility is licensed to serve 6 bedridden adults ages 60 and above. 5 bedrooms are cleared for bedridden residents. The facility is approved to admit or retain 2 residents on hospice. A total of 5 residents are currently residing in this facility. The Annual Licensing Fees are current. The LIC999 Facility Sketch (Floor Plan) that is on file in El Segundo Regional Office depicts the following: a one-story house with 5 resident bedrooms, 1 staff room, 3 bathrooms, 1 attached garage, and a great room with kitchen and living room. Facility Layout (LPA Observations): is a one-story house located in a residential street. The home consists of 6 resident bedrooms (resident bedroom 6 is designated as the staff in the LIC999); 3 full bathrooms; 1 staff room walls are not touching the ceiling (this room is not depicted on the LIC999); 1 great room which includes the kitchen area, dining table, and living room area; 1 attached garage; and 1 backyard patio area with shaded seating. Outside Grounds: were toured no bodies of water were observed and walkways around the home were clear of hazards Resident Bedrooms: 5 out of 5 resident bedrooms were toured. There is adequate lighting, plenty of dresser and closet space observed. Walls and floors were clean and in good condition. LPA reviewed resident records alongside Administrator, Jehn Demafelix. LPA informed the Administrator that resident records were incomplete. At around 1:00 PM, the Administrator left the facility and informed LPA that they will bring the requested records to the facility. At around 3:00 PM, Administrator, Irene Formentera arrived at the facility but did not bring the requested documentation for example, Resident 1’s (R1) Home Health Care Plan and R1’s to R5’s (Resident 5) pending doctors orders for bed rails. 5 resident records were reviewed and 5 out of 5 resident records were incomplete. Technical violations are being provided regarding: Physical Plant, Home Health, and Postural Supports. A deficiency is being provided regarding maintaining current and accurate records in the facility. An exit interview was conducted, Plans of Corrections were reviewed and developed. A copy of this report and appeal rights were discussed and left with the Administrator, Irene Formentera.