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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197607901
Report Date: 11/18/2025
Date Signed: 11/18/2025 04:31:34 PM

Document Has Been Signed on 11/18/2025 04:31 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:STARLIGHT CARE HOMEFACILITY NUMBER:
197607901
ADMINISTRATOR/
DIRECTOR:		ANA F. DUENASFACILITY TYPE:
740
ADDRESS:1704 KERRY COURTTELEPHONE:
(626) 824-6343
CITY:WEST COVINASTATE: CAZIP CODE:
91792
CAPACITY: 6CENSUS: 5DATE:
11/18/2025
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:20 PM
MET WITH:Andrew EscobarTIME VISIT/
INSPECTION COMPLETED:
04:35 PM
NARRATIVE
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Licensing Program Analyst (LPA) Galarza conducted an unannounced case management visit. LPA met with unofficially appointed Andrew Escobar. The purpose of the visit was to follow-up on items addressed during the Noncompliance Conference (NCC) meeting held on September 17, 2025.

License/Administrator Ana Duenas is on vacation for an extended period of time. *NOTE: Licensee did not notify CCL or submit LIC 308 "Designation of Facility Responsibility" delegating authority to appropriate staff during Licensee's absence.

During the NCC meeting licensee agreed to:

  1. Hire an additional staff member within 30 days of (9/17/25) that will work as needed for oversight of record documentation, and other facility responsibilities.
Status: Licensee Ana Duenas has not submitted to Community Care Licensing (CCL) proof
that a new staff member/Administrator has been hired. Mr. Andrew Escobar was hired on 11/3/25
but has not been associated to the facility. Licensee did not notify CCL of staffing changes.
  1. Submit pending Type B plan of corrections within 30 days.
Status: Licensee submitted plan of corrections.
  1. Licensee agreed to submit a written plan, update the Plan of Operation and facility sketch addressing live-in staff accommodations. If a permit for an additional dwelling unit (ADU) has been requested submit proof of documentation.
Status: Licensee/Administrator has not submitted an updated plan of operation, facility sketch, and a
written statement addressing live-in staff sleep accommodations. There are 2 live-in staff. One
sleeps in the garage and the other sleeps in the living room.

Andrew Escobar/Staff (S1's) file documents were obtained.
Pursuant to Title 22, citations were issued.
Exit interview was conducted and a copy of the report/appeal rights were issued to Andrew Escobar.
NAME OF LICENSING PROGRAM MANAGER: Lisa Hicks
NAME OF LICENSING PROGRAM ANALYST: Noemi Galarza
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 11/18/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/18/2025
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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Document Has Been Signed on 11/18/2025 04:31 PM - It Cannot Be Edited


Created By: Noemi Galarza On 11/18/2025 at 03:09 PM
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
, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754

FACILITY NAME: STARLIGHT CARE HOME
FACILITY NUMBER: 197607901

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/18/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
11/19/2025
Section Cited
CCR
87355(e)(3)

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Criminal Record Clearance. (e) All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1569.17(b) shall prior to working, residing or volunteering in a licensed facility: (3) Request a transfer of a criminal record clearance as specified in Section 87355(c) or
This requirement is not met as evidenced by:
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Licensee shall ensure that all persons prior to working at the facility are associated through Guardian system. A civil penalty was assessed.

Submit proof by tomorrow that S1 has been associated to the facility.
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This requirement was not met evidenced by:
Based on file review S1 was hired on 11/3/25, has criminal record clearance, but is not associated to the facility; which poses an immediate health, safety or personal rights risk to persons in care.
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Type A
11/19/2025
Section Cited
CCR87309(a)

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Storage Space and Access. (a) Except as specified in subsection (b), the licensee shall ensure that disinfectants, cleaning solutions, poisonous substances, knives, matches, tools, sharp objects, and other similar items which could pose a danger to residents are in locked storage and are not left unattended if outside the locked storage.
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Staff locked the kitchen knives cabinet and removed the scissors from bedroom #1.

Proof of staff training and a written plan of correction shall be submitted by tomorrow.
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Based on observation, there was a pair of unlocked scissors in resident (R1's) bedroom #1, unlocked knives and cleaning solutions in kitchen cabinets, and unlocked personal hygiene solutions stored in the living room, which poses an immediate health, safety or 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.
Lisa Hicks
NAME OF LICENSING PROGRAM MANAGER:
Noemi Galarza
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 11/18/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/18/2025


LIC809 (FAS) - (06/04)
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Document Has Been Signed on 11/18/2025 04:31 PM - It Cannot Be Edited


Created By: Noemi Galarza On 11/18/2025 at 03:35 PM
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
, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754

FACILITY NAME: STARLIGHT CARE HOME
FACILITY NUMBER: 197607901

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/18/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
11/25/2025
Section Cited
CCR
87208(a)

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Plan of Operation. The licensee shall have and maintain a current, written definitive plan of operation for the facility....Any significant changes in the plan of operation which would affect the services to residents shall be submitted to the licensing agency for approval. This requirement was not met evidenced by:
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Licensee shall submit a written plan of correction, updated Plan of Operation, updated facility sketch regarding live-in staff sleep arrangements and room occupancy.
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Based record review, the Licensee did not submit the following items agreed upon during the 9/17/2025 NCC meeting: written plan, updated Plan of Operation and updated facility sketch addressing live-in staff accommodations. This poses a potential health, safety or personal rights risk to persons in care.
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Type B
11/25/2025
Section Cited
CCR87412(a)(11)

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Personnel Records. The licensee shall ensure that personnel records are maintained on the licensee, administrator and each employee. Each personnel record shall contain the following information: A health screening as specified in Section 87411, Personnel Requirements - General. This requirement was not met evidenced by:
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Proof of staff (S1's) health screening/TB clearance shall be submitted by POC due date.
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Based on record review, staff (S1) was hired on 11/3/2025. Their file documents do not include a completed health screening/TB clearance. This poses a potential health, safety or 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.
Lisa Hicks
NAME OF LICENSING PROGRAM MANAGER:
Noemi Galarza
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 11/18/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/18/2025


LIC809 (FAS) - (06/04)
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Document Has Been Signed on 11/18/2025 04:31 PM - It Cannot Be Edited


Created By: Noemi Galarza On 11/18/2025 at 03:45 PM
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
, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754

FACILITY NAME: STARLIGHT CARE HOME
FACILITY NUMBER: 197607901

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/18/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
11/25/2025
Section Cited
CCR
87307(a)

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Personal Accommodations and Services. Living accommodations and grounds shall be related to the facility's function. The facility .... provide comfortable living accommodations and privacy for the residents, staff, and others who may reside in the facility. This requirement was not met evidenced by:
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Licensee/Administrator shall submit:
1. Written plan of correction addressing live-in staff accommodations and proof of plan of correction.

*NOTE: The plan of operation and facility sketch do not state there will be live-in staff.
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Based on observation and interviews conducted, live-in staff (S2) is sleeping in the living room, and live-in staff (S3) sleeps in the garage. This poses a potential health, safety or personal rights risk to persons in care.
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Type B
11/25/2025
Section Cited
CCR87303(a)

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Maintenance and Operation. The facility shall be clean, safe, sanitary and in good repair at all times. Maintenance shall include provision of maintenance services and procedures for the safety and well-being of residents, employees and visitors. This requirement was not met evidenced by:
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Licensee shall submit picture proof evidence that the entire facility has been deep cleaned. Submit pictures of kitchen counters and floors, backyard patio area, and garage.
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Based on observation, the facility interior and exterior physical plant is not clean and sanitary. All facility floors were dirty, kitchen counters and floors were dirty, and discarded furniture was observed in the backyard & garage. This poses a potential health, safety or 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.
Lisa Hicks
NAME OF LICENSING PROGRAM MANAGER:
Noemi Galarza
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 11/18/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/18/2025


LIC809 (FAS) - (06/04)
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Document Has Been Signed on 11/18/2025 04:31 PM - It Cannot Be Edited


Created By: Noemi Galarza On 11/18/2025 at 04:12 PM
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
, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754

FACILITY NAME: STARLIGHT CARE HOME
FACILITY NUMBER: 197607901

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/18/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
11/25/2025
Section Cited
CCR
87405(a)

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Administrator - Qualifications and Duties. All facilities shall have a qualified and currently certified administrator.... When the administrator is not in the facility, there shall be coverage by a designated substitute who shall have qualifications adequate to be responsible and accountable for management and administration of the facility as specified in this section....
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Licensee shall submit a copy of LIC 308 Designation of Facility Responsibility.
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Based on observation and staff interviews, Licensee left on vacation out of the country on Nov. 11, 2025, and did not submit to CCL LIC 308 Designation of Facility Responsibility appointing new staff as a facility representative. This poses a potential l health, safety or 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.
Lisa Hicks
NAME OF LICENSING PROGRAM MANAGER:
Noemi Galarza
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 11/18/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/18/2025


LIC809 (FAS) - (06/04)
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