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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198320370
Report Date: 10/03/2025
Date Signed: 10/03/2025 01:39:09 PM

Document Has Been Signed on 10/03/2025 01:39 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, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245
FACILITY NAME:OCEANVIEW ESTATEFACILITY NUMBER:
198320370
ADMINISTRATOR/
DIRECTOR:		DEMAFELIX, JEHN MARICFACILITY TYPE:
740
ADDRESS:30757 RUE VALOISTELEPHONE:
(310) 533-1131
CITY:RANCHO PALOS VERDESSTATE: CAZIP CODE:
90275
CAPACITY: 6CENSUS: 4DATE:
10/03/2025
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:40 AM
MET WITH:Jeanette Jneid - House ManagerTIME VISIT/
INSPECTION COMPLETED:
01:45 PM
NARRATIVE
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On 10/03/25 Licensing Program Analyst (LPA) Mario Leon made an unannounced annual inspection visit at the facility, using the care tool. LPA was met by staff one, Jeanette Jneid - House Manager (S1), and the purpose of the visit was explained. The facility is licensed to serve (6) elderly residents ages 60 and over. The fire clearance is approved for (2) ambulatory and (4) non-ambulatory, of which (4) may be bedridden. Bedridden in bedrooms #2, #3 and #5. Waiver/Granted for hospice care for (6). Currently, the facility has (4) residents.
LPA Leon toured the facility along with S1. The two-story home is located in a residential area and consists of six (6) client bedrooms, three (3) bathrooms and the second story is reserved for staff. The home also features one (1) living room, one (1) Kitchen, a dining area and laundry area. All client rooms were checked. Mattresses and box springs were in good condition, adequate lighting, plenty of dresser and closet space was observed. Walls and floors were clean and in good repair. Bed linens, comforters and bath towels were adequately stocked at the time of visit. Bathrooms were found to have non-skid mats, stable grab bars, yet the water temperature was measured at an average of 136.83 degrees Fahrenheit (136.8°F) which is outside of Title 22 regulation. Two (2) deficiencies have been cited, please see LIC809D. Toilets and water faucets worked properly. Showers were free of mold/mildew, adequate lighting, and sufficient toiletries accessible to clients. LPA observed 3-days of perishable and at least 7-days non-perishable food supply, which was checked and was properly stored and stocked at time of visit. Carbon monoxide/smoke detectors were operational and fire extinguisher was fully charged and operational (last maintained on 08/22/2025), toxins and sharps were locked and inaccessible to clients. Medications were locked and inaccessible to clients, first aid kit was checked and in order, including manual was present. Outside grounds were toured and no bodies of water were observed. Shaded area in backyard was accessible. Exits/Walkways around the home were free of debris and hazards. REPORT CONTINUES, see LIC809C.
NAME OF LICENSING PROGRAM MANAGER: Ulysses Coronel
NAME OF LICENSING PROGRAM ANALYST: Mario Leon
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 10/03/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/03/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 3 of 11
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, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245
FACILITY NAME: OCEANVIEW ESTATE
FACILITY NUMBER: 198320370
VISIT DATE: 10/03/2025
NARRATIVE
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Bedrooms number 1 and number 5 (#1, #5) both host non-ambulatory residents, which is beyond licensing limitations. One (1) deficiency has been cited, please see LIC809D. During the visit, LPA observed the facility infection control practices remaining in place. LPA observed screening protocols for visitors and a hand-sanitizing station were present. LPA observed appropriate gloves and mask available for staff or visitors.
During today’s visit there were three (3) deficiencies cited. Please see LIC809D.

An exit interview was held with staff one, Jeanette Jneid - House Manager (S1) and a copy of this report, appeal rights and three (3) deficiencies cited were provided to Jeanette Jneid.

NAME OF LICENSING PROGRAM MANAGER: Ulysses Coronel
NAME OF LICENSING PROGRAM ANALYST: Mario Leon
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 10/03/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/03/2025
LIC809 (FAS) - (06/04)
Page: 10 of 11
Document Has Been Signed on 10/03/2025 01:39 PM - It Cannot Be Edited


Created By: Mario Leon On 10/03/2025 at 10:36 AM
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
, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245

FACILITY NAME: OCEANVIEW ESTATE
FACILITY NUMBER: 198320370

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/03/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
87303(e)(2)
Maintenance and Operation
(e) Water supplies and plumbing fixtures shall be maintained as follows: (2) Faucets used by residents for personal care such as shaving and grooming shall deliver hot water. Hot water temperature controls shall be maintained to automatically regulate the temperature of hot water used by residents to attain a temperature of not less than 105 degree F (41 degrees C) and not more than 120 degree F (49 degrees C).

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on LPA measurement, the licensee did not comply with the section cited above in three (3) out of four (4) water sources are above 120°F, which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 10/06/2025
Plan of Correction
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LPA and House Manager have agreed that the water temperature will be reviewed daily for the following three (3) days. House Manager and/or staff will report the average daily water temperature. Water temperature shall be within title 22 regulations (105°F - 120°F).
Type A
Section Cited
CCR
87303(e)(3)
Maintenance and Operation
(e) Water supplies and plumbing fixtures shall be maintained as follows: (3) Taps delivering water at 125 degree F (52 degrees C) or above shall be prominently identified by warning signs.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on LPA measurement, the licensee did not comply with the section cited above in three (3) out of four (4) water sources are above 125°F which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 10/06/2025
Plan of Correction
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LPA and House Manager have agreed that the water temperature will be reviewed daily for the following three (3) days. House Manager and/or staff will report the average daily water temperature. Water temperature shall be within title 22 regulations (105°F - 120°F). If facility wishes to remain water temperature at this level (average 136.8°F), warning signs NOTING "WATER ABOVE 125°F" shall be placed in three (3) out of three (3) bathrooms.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Ulysses Coronel
NAME OF LICENSING PROGRAM MANAGER:
Mario Leon
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 10/03/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/03/2025


LIC809 (FAS) - (06/04)
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Document Has Been Signed on 10/03/2025 01:39 PM - It Cannot Be Edited


Created By: Mario Leon On 10/03/2025 at 12:01 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
, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245

FACILITY NAME: OCEANVIEW ESTATE
FACILITY NUMBER: 198320370

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/03/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
87204(b)
87204(b)
Limitations -Capacity and Ambulatory Status
(b) Resident rooms approved for 24-hour care of ambulatory residents only shall not accommodate nonambulatory residents. Residents whose condition becomes nonambulatory shall not remain in rooms restricted to ambulatory residents.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on LPA observation and record review, the licensee did not comply with the section cited above in two (2) out of six (6) resident bedroom(s) which are listed as "ambulatory only", yet bedrooms #1 and bedroom #5 host non-ambulatory residents which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 10/06/2025
Plan of Correction
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LPA and House Manager have agreed that residents will move to appropriate bedroom(s) as listed on current STD850 (Fire clearance) for resident retention through 10/06/25. Furthermore, the facility will update their STD850 as previously requested to LPA Leon, via email, at MARIO.LEON@DSS.CA.GOV
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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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.
Ulysses Coronel
NAME OF LICENSING PROGRAM MANAGER:
Mario Leon
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 10/03/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/03/2025


LIC809 (FAS) - (06/04)
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