198320513-5-8-2025-11-AS-YROR-DGGNYA-20250508105222

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 198320513
Report Date: 05/07/2025
Date Signed: 05/08/2025 10:52:51 AM

Document Has Been Signed on 05/08/2025 10:52 AM - 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:	CASTLE HEIGHTS ASSISTED LIVING		FACILITY NUMBER:	198320513
ADMINISTRATOR/ DIRECTOR:	JOAQUIN, LEIA		FACILITY TYPE:	740
ADDRESS:	3354 CARDIFF AVE		TELEPHONE:	(424) 289-4241
CITY:	LOS ANGELES	STATE: CA	ZIP CODE:	90034
CAPACITY: 6		CENSUS: 6	DATE:	05/07/2025
TYPE OF VISIT:	Prelicensing	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	09:07 AM
MET WITH:	Leia Joaquin, Administrator		TIME VISIT/ INSPECTION COMPLETED:	12:45 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	On 05/07/25 LPA Yolanda Rosser arrived at facility to conduct announced Pre-Licensing visit, met with Leia Joaquin, Administrator explained the purpose of the visit. LPA was granted entrance into the facility. Census is 6. LPA and Administrator toured the facility and consisted of the following: Facility is a one story house located on a residential street. The home consists of 6 resident bedrooms, 1 staff bedroom, 1 attached garage, 1 kitchen/dining/living room, 2 bathrooms, 1 covered patio area with shaded seating. The facility lawn is manicured and all pathways are clear and free of debris. the facility is very clean, no dishes in sink or on the counter. The facility has fresh flowers and plants making the house very inviting. The dining room area has a wide screen television and there is a variety of activities and games for the residents. All signs and menus are posted as required. There is a complete first aid kit. Restrooms are clean, showers are installed with non-slip surfaces, all trash cans have lids. There is a extra supply of toiletries and towels, bed linen located in the cabinet. The facility has fresh flowers and plants making the house very inviting. Continued on LIC C

NAME OF LICENSING PROGRAM MANAGER: Eva M Alvarez
NAME OF LICENSING PROGRAM ANALYST: Yolanda Rosser
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 05/07/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/07/2025

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, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245

FACILITY NAME: CASTLE HEIGHTS ASSISTED LIVING	FACILITY NUMBER: 198320513
	VISIT DATE: 05/07/2025

NARRATIVE

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Kitchen is neat and clean. Cutlery and cleaning products are locked. Cabinets are fully stocked with non-perishables and there is a abundance of food in the refrigerator and the freezer is fully stocked. There is at least a 7 day supply of perishable and non-perishable of food available. LPA tested hot water temperature and it measured between 105 and 110 degrees Fahrenheit.

The facility provides residents with hygiene products such as non-medicated soap, body wash, toilet paper, toothbrush, toothpaste, lotion, deodorant, body spray and any other products requested.

LPA observed medications were stored and locked, inaccessible. All medications observed were labeled and maintained in compliance with label instructions and State and Federal law. Documents are posted as mandated. Last fire and earthquake drill was conducted on 05/03/2025. First aid kit is fully stocked with manual. Smoke and carbon monoxide detectors were in compliance and operational. There are two fire extinguishers, and they were last serviced on 05/25.

4 Staff records were reviewed; Criminal Record Clearances, Job Applications, Tuberculosis Test, Facility Training's/Drills, and signed Employee Rights, all required documents were accounted for and reviewed.

5 Resident records were reviewed: Admission Agreements, Medical Assessments, Consent Forms, Weight Record, Emergency Information, Appraisal & Needs Service Plan, Tuberculosis Test, Centrally Stored Medication Destruction Record, and Personal Rights. all required documents were accounted for and reviewed.

Resident bedrooms were checked. Mattresses were in good condition, adequate lighting, plenty of dresser and closet space observed. Walls and floors were clean and in good condition. Comforters, bed linen, bath towels and mattress protectors were adequately stocked. Restroom toilets and water faucets worked properly; grab bars were secure.

An exit interview was conducted and a copy of this report was left with Leia Joaquin, Administrator.

NAME OF LICENSING PROGRAM MANAGER: Eva M Alvarez
NAME OF LICENSING PROGRAM ANALYST: Yolanda Rosser
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 05/07/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/07/2025

LIC809 (FAS) - (06/04)

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