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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198320496
Report Date: 10/06/2025
Date Signed: 10/06/2025 12:14:55 PM

Document Has Been Signed on 10/06/2025 12:14 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:SOFT HEART ASSISTED LIVINGFACILITY NUMBER:
198320496
ADMINISTRATOR/
DIRECTOR:		SUN, KEFACILITY TYPE:
740
ADDRESS:3342 ARTESIA BLVDTELEPHONE:
(310) 977-8599
CITY:TORRANCESTATE: CAZIP CODE:
90504
CAPACITY: 6CENSUS: 5DATE:
10/06/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:36 AM
MET WITH:Ke SunTIME VISIT/
INSPECTION COMPLETED:
12:00 PM
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On 10/06/2025, Licensing Program Analyst (LPA), Wendy Gibbs, conducted an unannounced Annual Visit to the facility listed above. LPA met with Licensee Ke Sun, 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 aged 60 and over and have an approved hospice waiver for four (4).
Physical Plant The facility is a single-story home in a residential neighborhood. The home consists of four (4) resident bedrooms, staff room, three (3) bathrooms, living room, sitting room, office area, kitchen, laundry room, detached garage, front and back yard. LPA observed a shaded patio with table and chairs. All windows and screens were observed clean and in good repair. LPA observed all walkways around the facility are clean, clear, and free of debris, hazards, and obstructions. All fences open easily from the inside to exit. The facility does have a fireplace that is screened and inaccessible to residents.
Bedrooms LPA inspected all resident rooms and observed them to be clean and in good repair. LPA observed the rooms have the required furniture including a bed, dresser, nightstand, chair, and storage space for personal belongings. LPA observed the beds have the required linens including a mattress cover, fitted sheets, blanket, comforter, and pillows. LPA observed a supply of linens in a cabinet in the hallway. All linens and mattresses were observed in good repair. All bedrooms were observed to have ample lighting.
Bathrooms LPA inspected all bathrooms and observed them to be operable and within Title 22 regulations. The toilet, facets, and shower work properly. The bathrooms were observed clean and showers free of mildew and mold. The showers were observed with secured safety handrails, nonskid mats, and a shower chair. LPA observed storage space for residents’ hygiene products. LPA observed an ample supply of towels in a cabinet in the hallway. LPA observed a supply of hygiene products available for residents in a closet at the entrance of the facility. The water temperature measured between 112.3 -degrees, 111.4- degrees and 115.6 -degrees Fahrenheit.
NAME OF LICENSING PROGRAM MANAGER: Eva M Alvarez
NAME OF LICENSING PROGRAM ANALYST: Wendy Gibbs
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 10/06/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/06/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 4
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: SOFT HEART ASSISTED LIVING
FACILITY NUMBER: 198320496
VISIT DATE: 10/06/2025
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Kitchen LPA inspected the kitchen and observed it to be clean and sanitary. LPA observed all appliances to be operational and in good repair. LPA observed a 3-day supply of perishable foods and a 7-day supply of nonperishable foods properly labeled, dated, and packaged. The water temperature measured 110.2-degree Fahrenheit. LPA observed an ample supply of cookware, dishware, and cutlery. LPA observed knives and sharps are secured in a locked cabinet in the kitchen and are inaccessible to residents. LPA observed cleaning supplies are secured in a locked cabinet under the kitchen sink and are inaccessible to residents.
Common Rooms In the living room LPA observed a couch and chairs to accommodate all residents. In the sitting room LPA observed chairs available for residents. The dining room has a large table with chairs to accommodate all residents. LPA observed in the laundry room a washer and dryer in good repair and are operational. All cleaning supplies and detergents were observed secured in a locked cabinet above the washer and dryer. All walkways and hallways in the facility were observed to be clean, clear, and free of obstructions and hazards. LPA observed ample lighting and night lights in all common rooms, walkways, and hallways. LPA observed games, activities and reading material available for residents.
Medications LPA observed all Centrally Stored Medications were secured in a locked cabinet in the dining room and are inaccessible to residents. All medications were observed in their original containers. LPA reviewed the medications and Medication Administration Record (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 and reviewed the facility Disaster Plan and Emergency Plan (last reviewed on 07/12/2025) and emergency numbers posted in the facility. LPA observed all required posting posted. LPA observed smoke detectors and carbon monoxide detectors are operational. LPA observed a facility sketch posted in the workspace in the sitting room. LPA observed two (2) fully charged fire extinguishers, one mounted in the kitchen and the other in the laundry room, last serviced on 07/21/2025. The last Emergency Drill was conducted on 09/12/25. LPA observed emergency flashlights in a drawer in the office area in the dining room. LPA inspected the First Aid Kit and observed it had the required items and a current manual. The facility has a working telephone. There are no firearms or ammunition on the premises.
Files LPA reviewed the files for five (5) residents and observed they contained the required documents. LPA reviewed the administrator and three (3) staff files and observed they contained the required documents, clearance, certification, and training. The administrator’s Administrator Certificate, number 6071632740 is valid till 07/24/2026. LPA received and reviewed a copy of Liability Insurance through IPFS Corporation of California that is valid till 08/21/26. LPA informed Licensee that Licensing Fees are due on 10/22/2025.
NAME OF LICENSING PROGRAM MANAGER: Eva M Alvarez
NAME OF LICENSING PROGRAM ANALYST: Wendy Gibbs
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 10/06/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/06/2025
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: SOFT HEART ASSISTED LIVING
FACILITY NUMBER: 198320496
VISIT DATE: 10/06/2025
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Infection Control LPA observed the facility’s Infection Control practices. At the entrance of the facility is a sanitizing station. LPA observed a Visitor Log with screening and temperature log. LPA observed hand sanitizer and masks available. LPA observed infection control signs posted throughout the facility. LPA observed a 60-day supply of Personal Protective Equipment (PPE) in the closet in the sitting room and in the garage .

During today’s visit, LPA did not observe or cite any deficiencies.

An exit interview was conducted with Licensee, Ke Sun, 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: 10/06/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/06/2025
LIC809 (FAS) - (06/04)
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