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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198603276
Report Date: 03/13/2025
Date Signed: 03/13/2025 01:20:17 PM

Document Has Been Signed on 03/13/2025 01:20 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
GREATER LA AC/SC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754
FACILITY NAME:YEARLING BOARD AND CAREFACILITY NUMBER:
198603276
ADMINISTRATOR/
DIRECTOR:		TANGONAN, MARIA ISABELFACILITY TYPE:
740
ADDRESS:11439 YEARLING CIRCLETELEPHONE:
(562) 307-7668
CITY:CERRITOSSTATE: CAZIP CODE:
90703
CAPACITY: 6CENSUS: 6DATE:
03/13/2025
TYPE OF VISIT:Case Management - Health ChecksUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:23 AM
MET WITH:Maria Isabel Tangonan, Administrator TIME VISIT/
INSPECTION COMPLETED:
01:27 PM
NARRATIVE
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Licensing Program Analyst (LPA) Alberto Lopez made unannounced healthy and safety case management visit to check on 2 new relocated residents who were relocated on 3/05/2025 and 03/06/2025 from Jennae Crest - 197607853. LPA met with Maria Isabel Tangonan, Administrator and explained the purpose of the visit. A physical plant tour of the facility was completed.

The following observations were made:

· Resident (R1) is in a shared room, R2 is in private room. The rooms have required furniture.
· Medication Administration Records (MARs), medications, resident file documents were reviewed.
· Sufficient staff was observed and providing care.
· No slip mat was observed in one restroom.
· LIC 500 Personnel Report needs to be updated.
· The facility has sufficient 2-day perishable and 7-day nonperishable food supplies.
· The last fire drill was conducted on 01/05/2025.
· Full rails were observed in R1's bed. However, resident has required doctor’s orders. Full rails were observed for R2, However, the resident is enrolled in hospice services.
· Smoke Alarms were tested and operational.


Exit interview was conducted with Administrator Maria Isabel Tangonan and a copy of the report was issued. Appeal rights provided
SUPERVISORS NAME: Lisa Hicks
LICENSING EVALUATOR NAME: Alberto Lopez
LICENSING EVALUATOR SIGNATURE: DATE: 03/13/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/13/2025
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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Document Has Been Signed on 03/13/2025 01:20 PM - It Cannot Be Edited


Created By: Alberto Lopez On 03/13/2025 at 01:01 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
, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754

FACILITY NAME: YEARLING BOARD AND CARE
FACILITY NUMBER: 198603276

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/13/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
03/14/2025
Section Cited
CCR
87303(e)(5)

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(e) Water supplies and plumbing fixtures shall be maintained as follows: (5) Slip-resistant mats, strips, or flooring shall be used in all bathtub and shower floors.


This requirement is not met as evidenced by
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Administrator purchased slip mat for restroom adjacent to living room during visit..

****NO FURTHER ACTION REQUIRED****
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There is no slip mat in the restroom adjacent to the living room which poses a health and safety risk to persons in care.
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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.
SUPERVISOR'S NAME:Lisa Hicks
LICENSING EVALUATOR NAME:Alberto Lopez
LICENSING EVALUATOR SIGNATURE:
DATE: 03/13/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/13/2025


LIC809 (FAS) - (06/04)
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