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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198603391
Report Date: 02/06/2025
Date Signed: 02/06/2025 03:01:00 PM

Document Has Been Signed on 02/06/2025 03:01 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:HASTINGS RANCH HOMEFACILITY NUMBER:
198603391
ADMINISTRATOR/
DIRECTOR:		ESTANISLAO, RALPHFACILITY TYPE:
740
ADDRESS:1230 HASTINGS RANCH RDTELEPHONE:
(626) 351-1150
CITY:PASADENASTATE: CAZIP CODE:
91107
CAPACITY: 6CENSUS: 3DATE:
02/06/2025
TYPE OF VISIT:POCUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
02:34 PM
MET WITH:Noel Navarro - Caregiver TIME VISIT/
INSPECTION COMPLETED:
03:15 PM
NARRATIVE
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Licensing Program Analyst(s)(LPA)s Mary Flores and Blanca Gonzalez conducted an unannounced plan of correction (POC) visit to follow up on deficiencies noted on 1/28/25. LPAs met Noel Navarro with and explained the reason for the visit.

On 1/28/25 LPA Flores conducted an annual visit and noted the following deficiency:
Type A - Section 87705(l)(2) Care of Persons with Dementia: On 1/28/25 LPA observed main entrance door had a lock that required a key on both sides (indoor and outdoor). On 2/6/25 LPA observed the lock had been switched to a lock with a latch on the inside and a key required on the outside. Deficiency cleared as of 2/6/25.

Exit interview was conducted with Marissa Carreon and a copy of this report was provided.
SUPERVISORS NAME: Tony Vasallo
LICENSING EVALUATOR NAME: Mary G Flores
LICENSING EVALUATOR SIGNATURE: DATE: 02/06/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/06/2025
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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