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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198204938
Report Date: 05/15/2025
Date Signed: 05/15/2025 05:00:34 PM

Document Has Been Signed on 05/15/2025 05:00 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:BRENT WOOD VILLAFACILITY NUMBER:
198204938
ADMINISTRATOR/
DIRECTOR:		KENNETH PITTSFACILITY TYPE:
740
ADDRESS:17004 ATKINSON AVENUETELEPHONE:
(310) 538-2284
CITY:TORRANCESTATE: CAZIP CODE:
90504
CAPACITY: 6CENSUS: 5DATE:
05/15/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:27 PM
MET WITH:Bienvenido CadungogTIME VISIT/
INSPECTION COMPLETED:
05:00 PM
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On 05/15/2025, Licensing Program Analyst (LPA), Wendy Gibbs, conducted an unannounced Annual Visit to the facility listed above. LPA met with Licensee, Bien Cadungog and the purpose of today’s visit was explained.
The facility is licensed to serve six (6) non-ambulatory residents aged 60 and older. The facility has an approved hospice waiver for three (3) residents.
Physical Plant/Structure The facility is a single-story home located in a residential neighborhood. It consists of six (6) resident rooms, three (3) bathrooms, living room, dining room, kitchen, detached garage, staff room, and an outside covered patio with table and chairs. LPA observed all walkways around the facility are clean, clear, and free of debris, hazards, and obstructions. All safety handrails around the facility were observed secured. LPA did not observe any bodies of water on the premises.
Bedrooms LPA inspected the resident bedrooms and observed them to be clean and in good repair. LPA observed all bedrooms have the required furniture including a bed, dresser, nightstand, chair, and ample storage space for resident’s
NAME OF LICENSING PROGRAM MANAGER: Eva M Alvarez
NAME OF LICENSING PROGRAM ANALYST: Wendy Gibbs
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 05/15/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/15/2025
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: BRENT WOOD VILLA
FACILITY NUMBER: 198204938
VISIT DATE: 05/15/2025
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personal belongings. LPA observed resident beds have the required linens including a mattress cover, fitted sheets, blankets, comforter, and pillows. All beds and bedding were observed in good repair. LPA observed an ample supply of linens in the closet in the hall. LPA observed all rooms have ample lighting.
Bathrooms LPA inspected the bathrooms and found them to be within Title 22 regulations. LPA observed the bathrooms to be clean and operational. All showers were observed clean and free of mold and/or mildew. All showers have non-slip mats and shower chairs. LPA observed an ample supply of toiletries for clients and client’s toiletry buckets. LPA observed the bathrooms have secured safety handrails. The water temperature measured 105.1-degrees, 105.6-degrees and 106-degrees Fahrenheit.
Kitchen LPA inspected the kitchen and found it to be clean and sanitary. LPA observed all appliance are operational and in good repair. LPA observed an ample supply of cookware, dishware, and cutleries. LPA observed a 3-day supply of perishable foods, and a 7-day supply of nonperishable foods properly stored and labeled. LPA observed sharps and knives secured in a locked drawer and are inaccessible to residents. LPA observed all cleaning supplies secured in a locked cabinet and are inaccessible to residents. The water temperature measured 105.3-degrees Fahrenheit.
Common Rooms LPA observed a sitting area with a recliner, and two couches. The living room has a large couch and armchair to accommodate all residents. LPA observed the dining room has a large table and chairs to accommodate all residents. LPA observed the facility to be appropriately furnished during time of visit. LPA observed all walkways and hallway in the facility were observed with
NAME OF LICENSING PROGRAM MANAGER: Eva M Alvarez
NAME OF LICENSING PROGRAM ANALYST: Wendy Gibbs
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 05/15/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/15/2025
LIC809 (FAS) - (06/04)
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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: BRENT WOOD VILLA
FACILITY NUMBER: 198204938
VISIT DATE: 05/15/2025
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ample lighting and were clean and clear and free of obstructions and hazards. LPA observed a fireplace that is screened and inaccessible to residents. LPA observed games, activities, and crafts. The facility was maintained at a comfortable temperature.
Files LPA observed files secured in a locked cabinet in the kitchen and are inaccessible to residents and guests. LPA reviewed the Administrator and two (2) staff files. LPA observed the staff files have the required documents, certification, and training. The Administrator Certificate is valid till 03/11/2027. LPA reviewed the files for five (5) residents and observed they have the required documents. LPA informed Administrator that licensing fees are due 05/22/2025 and provided the pin for online payment.
Medications LPA observed all centrally stored medication secured in a locked cabinet in the kitchen. All medications were observed in their original packaging. LPA reviewed the medication and medication administration records (MAR) for five (5) residents. LPA observed five (5) out of five (5) resident’s medications are consistent with properly documented records.
Safety LPA observed all smoke/carbon monoxide detectors are operable. LPA observed two (2) fully charged fire extinguishers in the facility last serviced on 06/24/2024. The last inspection from the Torrance Fire Department was conducted on 06/24/2024. The last emergency drill was conducted on 02/04/2025. LPA observed all doors have an alarm that chime when the doors are opened. All exits are marked with an EXIT sign. LPA reviewed the facility Emergency Disaster Plan (LIC610-D). LPA observed all required licensing postings throughout the facility. The facility has a working landline telephone. LPA inspected the First Aid kits and
NAME OF LICENSING PROGRAM MANAGER: Eva M Alvarez
NAME OF LICENSING PROGRAM ANALYST: Wendy Gibbs
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 05/15/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/15/2025
LIC809 (FAS) - (06/04)
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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: BRENT WOOD VILLA
FACILITY NUMBER: 198204938
VISIT DATE: 05/15/2025
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found it was fully stocked and had the required items including the manual. There are no security bars over the windows. No firearms or ammunition are stored on the premises.
Infection Control During the tour, LPA observed the facility’s infection control practices. LPA observed a sanitizing station at the facility entrance with a visitor’s log, thermometer, and masks available. Sufficient paper, cleaning, and disinfecting supplies were observed. LPA observed required infection control postings throughout the facility.

LPA did not observe or cite any deficiencies.

An exit interview was conducted with Administrator, Bien Candungog, and a coy 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: 05/15/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/15/2025
LIC809 (FAS) - (06/04)
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