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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198603276
Report Date: 09/11/2025
Date Signed: 09/11/2025 03:57:20 PM

Document Has Been Signed on 09/11/2025 03:57 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
MONTEREY PARK ASC, 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:
09/11/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:35 PM
MET WITH:Connie Duldulao, CaregiverTIME VISIT/
INSPECTION COMPLETED:
04:05 PM
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Licensing Program Analysts (LPAs) Daniel Konishi and Gabriela Castro conducted an unannounced Annual/Required inspection and met with Caregiver, Connie Duldulao and explained the purpose of the visit. Staff #1 (S1) helped assist with the visit. Administrator, Maria Tangonan arrived shortly after and LPAs explained the purpose of the visit. The facility is licensed for the age range 60 and over to serve six (6) non-ambulatory, of which one (1) may be bedridden. Bedridden in bedroom #2. Hospice Waiver for six (6).

LPAs utilized the Compliance and Regulatory Enforcement (CARE) tools for the visit, today’s visit and the initial visit and observed the following:

Infection Control:

Infection control practices and Personal Protective Equipment (PPEs) were observed. LPAs observed that the facility has an infection control plan in place.


Operational Requirements:



Fire clearance was approved by LA County Fire Department for the age range 60 and over to serve six (6) non-ambulatory, of which one (1) may be bedridden. Bedridden in bedroom #2. Hospice Waiver for six (6).. Liability Insurance is valid and currently on file.
NAME OF LICENSING PROGRAM MANAGER: David Sicairos
NAME OF LICENSING PROGRAM ANALYST: Daniel Konishi
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 09/11/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/11/2025
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
MONTEREY PARK ASC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754
FACILITY NAME: YEARLING BOARD AND CARE
FACILITY NUMBER: 198603276
VISIT DATE: 09/11/2025
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Physical Plant/Environment Safety:

This home contains 5 resident bedrooms, 1 staff bedroom, 2 bathrooms, 1 staff bathroom, living room, kitchen, dining room and an attached garage with a storge room inside of the garage. LPAs toured the facility with S1 and observed all (5) resident bedrooms, containing required furniture, lamps, dresser, chair, and closet space. The three bathrooms contain a working toilet, basin, and water faucet, walk in shower with grab bar, shower chair, and bathmat. Cleaning Supplies are secured and inaccessible to residents and locked underneath the kitchen sink. Sharps are secure and locked in a kitchen drawer. LPAs measured the water temperature at 109.4*F in bathroom #1, 112.6 degrees F in bathroom #2-, and 113.5-degrees F in bathroom #3 which are within Title 22 regulations. The carbon monoxide detector was located throughout the facility, tested, and functioning properly. There were three (3) fire extinguishers located in the kitchen, hallway and garage fully charged and up to date. The outdoor grounds were toured and inspected, and the patio was well maintained with a shaded seating area accessible for client use. The garage contained a working washer and dryer, with cabinetry that contained emergency supply kits, bottled water, toiletries, personal care supplies, and toxins and cleaning agents stored locked and inaccessible to the clients. There are no bodies of water.

Staffing:

A total of four (4) full-time staff members provide care and supervision to the residents.

Personnel Records/Staff Training:

LPAs reviewed Four (4) staff files that include personnel records, health/TB screenings, employee rights, criminal background clearance, 1st Aid/CPR/AED training, and staff training. Administrator’s Certificate is valid and expires on 10/30/2025.



Resident Rights/Information:

Residential Care Facility for the Elderly Complaint Poster (PUB 475) posted on the wall. Residents’ Personal Rights posted on the wall. Facility provides internet access for residents.

Planned Activities:

The facility has planned activities with monthly activity calendar and activity log. Facility has sufficient space to accommodate indoor and outdoor activities that are easily accessible.
NAME OF LICENSING PROGRAM MANAGER: David Sicairos
NAME OF LICENSING PROGRAM ANALYST: Daniel Konishi
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 09/11/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/11/2025
LIC809 (FAS) - (06/04)
Page: 3 of 4
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK ASC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754
FACILITY NAME: YEARLING BOARD AND CARE
FACILITY NUMBER: 198603276
VISIT DATE: 09/11/2025
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Food Service:

The kitchen was inspected and has sufficient supply of 2-day perishable & 7-day non-perishable food. Kitchen, food preparation area, and storage areas were observed to be clean and sanitary.

Incidental Medical and Dental:

Residents are assisted with self-administration of prescription and non-prescription medications. LPAs reviewed five (5) centrally stored resident medication records. Centrally stored medications are kept in a safe and locked place not accessible to residents in care. Medications are given according to Physician directions. The first Aid kit had all the required items.

Resident Records/Incident Reports: LPAs reviewed five (5) resident files containing Admission Agreements, Physician's Report, Ambulatory Status, TB clearance, Pre-Placement Appraisal, Appraisal/Needs and Services Plan, personal rights.

Disaster Preparedness:

A posted Emergency Disaster Plan LIC 610D containing emergency evacuation information was observed. An emergency drill was conducted in 09/11/2025. No manual restraints or seclusions are used in residents in care.

Residents with Special Health Needs:

There are two (2) residents that are provided hospice care services and LPAs reviewed a hospice care plan for one (1) resident. There are residents with postural support at this facility and LPAs reviewed staff training on postural supports. Full and Half bed rails for mobility assistance were observed in some resident rooms and LPA reviewed resident files with full and half bed rail orders. The facility is free from odors of incontinence.

Per the California Code of Regulations, Title 22, and California Health and Safety Code, there were no deficiencies observed during today’s visit. An exit interview was held and a copy of the report was provided to the Administrator, Maria Tangonan.

NAME OF LICENSING PROGRAM MANAGER: David Sicairos
NAME OF LICENSING PROGRAM ANALYST: Daniel Konishi
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 09/11/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/11/2025
LIC809 (FAS) - (06/04)
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