197610751-9-11-2025-31-AS-TSMH-DLESGX-20250911135239

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197610751
Report Date: 09/11/2025
Date Signed: 09/11/2025 01:53:02 PM

Document Has Been Signed on 09/11/2025 01:53 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, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364

FACILITY NAME:	ALAGA HOMES INC		FACILITY NUMBER:	197610751
ADMINISTRATOR/ DIRECTOR:	DE ROXAS, JEZRYL		FACILITY TYPE:	740
ADDRESS:	9806 GERALD AVE		TELEPHONE:	(323) 907-2623
CITY:	NORTHRIDGE	STATE: CA	ZIP CODE:	91343
CAPACITY: 6		CENSUS: 0	DATE:	09/11/2025
TYPE OF VISIT:	Prelicensing	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	10:15 AM
MET WITH:	Jonah Lansangan, Licensee		TIME VISIT/ INSPECTION COMPLETED:	01:58 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	At 10:15 am Licensing Program Analyst (LPA) Tihesha Smith conducted an announced pre-licensing visit with the Licensee (Jonah Lansangan)and administrator Jezryl De Roxas. Identification of both was verified by CA driver’s license. The facility has a capacity of six (6). Application received one (1) non-ambulatory and 5-bedridden clients. The purpose of today’s visit is to inspect the facility to ensure that the facility is in compliance with the rules and regulations of California Code of Regulations, Title 22, Division 6. Today's site visit consisted of LPA touring the physical plant inside and outside and observed the following: The facility is a single-story building. The common areas (kitchen, living room, and dining areas) were appropriately furnished, and the lighting was adequate. The living room has a television and comfortable furniture. The appliances in the kitchen appeared to be functional and in good repair. The sharps are stored and locked in a kitchen drawer. The laundry room is accessed through the kitchen and the washer/dryer was observed to be in good repair. Toxins stored and locked in laundry room cabinet. There are two (2) wall mounted fire extinguishers: one (1) in the dining room and one (1) in the kitchen. Fire extinguisher observed to be fully charged. Dual Smoke and Carbon Monoxide detectors were observed all over the facility, tested, and observed to be operational at approximately 1:35 pm.

NAME OF LICENSING PROGRAM MANAGER: Naira Margaryan
NAME OF LICENSING PROGRAM ANALYST: Tihesha Smith
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 09/11/2025

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/11/2025

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
CCLD Regional Office, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364

FACILITY NAME: ALAGA HOMES INC	FACILITY NUMBER: 197610751
	VISIT DATE: 09/11/2025

NARRATIVE

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Cont. from 809)
There is a functioning telephone/landline on the premises. An emergency exit plan/sketch is posted on the dining room wall next to the kitchen will be replaced with updated sketch. There are two (2) bathrooms in the facility: The hot water was tested for the bathrooms and measured at 118.0 (resident bathroom) and 125.0 (for guest bathroom- with posted caution hot water sign). The bathrooms have non-skid mats, trash cans with lids and functional grab bars.

There are six (6) client bedrooms: no room is designated for staff use. Client bedrooms were
observed to be appropriately furnished with a bed, nightstand, dresser, and chair. Two (2) of the six (6) bedrooms have built-in closets. The other four (4) rooms will have a free standing wardrobe closet. The licensee provided proof of purchase of the additional wardrobe closets during the visit and will send photos of the installed showroom wardrobe closet. Extra linen is stored in the living room cabinet along with facility games/activity tools.

Medications and first aid kit are stored in locked the living room closet. Client and staff records are stored in cabinets which are located in the locked garage/office. The garage has no indoor access and used to store emergency water and food supply, including PPEs and office has a staff refrigerator.
The backyard has the following: one covered area with a large table and several chairs to provide sufficient seating for the clients.
There is no body of water on the property.
Component III was conducted with the administrator and administrator confirmed understanding of
Title 22.

The facility appears to be clean and in good repair. At the time of visit this facility is ready to be licensed upon proof of wardrobe closet photo and posted facility sketch.

This report will be forwarded to the Centralized Application Bureau (CAB).

Exit interview was conducted and a copy of this report was provided.

NAME OF LICENSING PROGRAM MANAGER: Naira Margaryan
NAME OF LICENSING PROGRAM ANALYST: Tihesha Smith
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 09/11/2025

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/11/2025

LIC809 (FAS) - (06/04)

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