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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198603538
Report Date: 10/03/2022
Date Signed: 10/03/2022 03:00:16 PM

Document Has Been Signed on 10/03/2022 03:00 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
CCLD Regional Office, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754
FACILITY NAME:ALL IN CAREHOMEFACILITY NUMBER:
198603538
ADMINISTRATOR:YAMASHIRO, SHELLYFACILITY TYPE:
740
ADDRESS:1158 BEAVER WAYTELEPHONE:
(626) 698-9615
CITY:LA VERNESTATE: CAZIP CODE:
91750
CAPACITY: 6CENSUS: 5DATE:
10/03/2022
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
02:35 PM
MET WITH:Edwin UyTIME COMPLETED:
03:30 PM
NARRATIVE
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Licensing Program Analyst (LPA) conducted a case management visit as On 9/13/22, LPA Wong conducted an annual inspection under the old license facility name- DIAMOND CREST HOME CARE INC. 197606998 and observed there's a live in staff room in the garage and LPA spoke to administrator YAMASHIRO, SHELLY and admitted that the room was just recently built in as a storage room and LPA did not observe any city permit and the room was not indicate on the facility sketch and the facility was never reported to the Licensing about the change.

Deficiencies were noted on LIC809D per Title 22 Division 6 Chapter 8.

Exit interview was conducted with Staff
SUPERVISORS NAME: Christine Yee
LICENSING EVALUATOR NAME: Christine Wong
LICENSING EVALUATOR SIGNATURE: DATE: 09/30/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/30/2022
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 2
Document Has Been Signed on 10/03/2022 03:00 PM - It Cannot Be Edited


Created By: Christine Wong On 10/03/2022 at 02:45 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: ALL IN CAREHOME
FACILITY NUMBER: 198603538

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/03/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
10/17/2022
Section Cited
CCR
87035(a)

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87305 Alterations to Existing Building or New Facilities (a) Prior to construction or alterations, all facilities shall obtain a building permit.
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The administrator will ensure prior to construction or alteration, all facilities shall obtain a building permit. The administrator will go and obtain a city permit and also updated the facility sketch and send it to LPA by POC date.
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The requirement was not met as evidenced by LPA observation- LPA observed there's a live in staff room in the garage which was not indicate on the facility sketch and administrator admitted there's no city permit.
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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:Christine Yee
LICENSING EVALUATOR NAME:Christine Wong
LICENSING EVALUATOR SIGNATURE:
DATE: 10/03/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/03/2022


LIC809 (FAS) - (06/04)
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