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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198204651
Report Date: 09/05/2025
Date Signed: 09/05/2025 05:06:53 PM

Document Has Been Signed on 09/05/2025 05:06 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
EL SEGUNDO ASC, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754
FACILITY NAME:HEARTS OF PARADISE HOMEFACILITY NUMBER:
198204651
ADMINISTRATOR/
DIRECTOR:		BESSIE L COELLOFACILITY TYPE:
740
ADDRESS:4139 W. 177TH ST.TELEPHONE:
(310) 371-7950
CITY:TORRANCESTATE: CAZIP CODE:
90504
CAPACITY: 6CENSUS: 6DATE:
09/05/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
02:30 PM
MET WITH:TIME VISIT/
INSPECTION COMPLETED:
05:00 PM
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On 09/05/25, Licensing Program Analyst (LPA), Wendy Gibbs, conducted an unannounced annual visit to the facility listed above. LPA met with Administrator, Bessie Coello, and the purpose of today’s visit was explained. LPA was granted entry into the facility. The facility is licensed to serve six (6) non-ambulatory residents over the age of 60. The facility has an approved hospice waiver for four (4).
Physical Plant/Structure The facility is a single-story structure located in a residential neighborhood. It consists of the following: four (4) resident rooms, 2 bathrooms, living room, dining room, kitchen, laundry area, detached garage, and outside shaded patio area. On the outside patio, LPA observed a table with umbrella and chairs available for resident use. LPA observed all walkways around the facility to be clean, clear, and free of obstructions, debris, and hazards. LPA did not observe any bodies of water on the premises.
Bedrooms LPA inspected all residents’ rooms and observed the walls and floors to be in good repair. LPA observed all resident rooms had the required furniture including a bed, dresser, nightstand, chair, storage space for personal belonging, and ample lighting. LPA observed all beds had the required linens including a mattress cover, fitted sheet, blanket, comforter, and pillows. Beds and bedding were observed in good condition. LPA observed an ample supply of bed linens, and comforters at the time of visit.
Bathrooms LPA inspected the facility bathrooms and found them to be within Title 22 regulations. All bathrooms were observed clean and operational. LPA observed storage area for personal hygiene products. LPA observed an ample supply of towels and personal hygiene products available for residents. All showers had non-slip material, shower chairs and secured safety handrails. The water temperature measured 108.3-degrees and 109.1-degrees Fahrenheit.
Kitchen LPA inspected the kitchen and observed it to be clean and sanitary. LPA observed all appliances to be operable and in good repair. LPA observed an ample supply of dishware, cookware, and cutlery. LPA
NAME OF LICENSING PROGRAM MANAGER: Eva M Alvarez
NAME OF LICENSING PROGRAM ANALYST: Wendy Gibbs
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 09/05/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/05/2025
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
EL SEGUNDO ASC, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754
FACILITY NAME: HEARTS OF PARADISE HOME
FACILITY NUMBER: 198204651
VISIT DATE: 09/05/2025
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observed a 3- day supply of perishable foods, and a 7- day supply of non-perishable foods properly stored, dated, and labeled. The water temperature measured 109.9- degrees Fahrenheit. All sharps are secured in a locked cabinet and are inaccessible to residents. All cleaning supplies are secured in a locked cabinet under the kitchen sink and are inaccessible to residents.
Common Rooms LPA observed the facility to be appropriately furnished during the time of visit. The facility has a living room with recliners to accommodate residents. The dining room has a large table to accommodate residents for meals. LPA observed all walkways and hallways to be clean, clear, and free of hazards and obstructions. All rooms were observed with ample lighting. The facility was kept at a comfortable temperature.
Safety LPA observed a fully charged fire extinguisher located in the kitchen, last serviced on 08/21/25. All smoke and carbon monoxide detectors are operable. The last emergency drill was conducted on 07/29/25. The last Fire Prevention Inspection was completed by the Torrance Fire Department on 03/28/25. All exits are indicated with an EXIT sign. The facility sketch is posted at the entrance of the facility. The facility’s Emergency and Disaster Plan is posted and was last updated on 10/01/2024. LPA observed all required documents posted in the facility. The facility has a working landline telephone. There are no firearms or ammunition stored at the facility.
File Review LPA reviewed the files for the six (6) residents and observed they had the required documents. LPA reviewed the administrator and four (4) staff files and found they contained the required documents, certification, and training. LPA reviewed the Liability Insurance through Acord valid through 11/03/25. The administrator’s Administrator Certificate is valid through 01/04/27. During facility file review, LPA observed licensing fees were current.
Medication LPA observed all Centrally Stored Medications secured in a locked cabinet, in the laundry room, and are inaccessible to residents. All medications were observed in their original packaging. LPA reviewed the medications and Medication Administration Record (MAR) for the three (3) residents. Three (3) out of three (3) residents’ MARs and medication are consistent with properly documented records.
Infection Control Upon entry, LPA observed a sanitizing station and visitor sign-in log. LPA observed on the table there is hand sanitizer and masks available. Upon entry, LPA was screened for Covid-19 symptoms and temperature was taken and recorded. LPA observed all staff wearing face masks. LPA observed all required Infection Control signs posted in the facility. LPA observed a 30-day supply of Personal Protective Equipment (PPE). LPA observed a PPE cart in the entrance of facility and in the bathroom.
LPA did not observe or cite any deficiencies.
An exit interview was conducted with Administrator, Bessie Coello, and a copy of this report was provided.
NAME OF LICENSING PROGRAM MANAGER: Eva M Alvarez
NAME OF LICENSING PROGRAM ANALYST: Wendy Gibbs
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 09/05/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/05/2025
LIC809 (FAS) - (06/04)
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