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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198603538
Report Date: 03/07/2024
Date Signed: 03/07/2024 02:04:31 PM

Document Has Been Signed on 03/07/2024 02:04 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: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: 6DATE:
03/07/2024
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
01:11 PM
MET WITH:Caregiver Rosalyne ObedozaTIME COMPLETED:
02:00 PM
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CASE MANAGEMENT FINDINGS:
LPA Ramirez conducted case management deficiencies visit on 03/07/24, stemming from initial complaint investigation on 03/07/2024. LPA Ramirez and Administrator Shelly Yamashiro toured facility garage together. LPA Ramirez observed a cloth room divider near corner of garage, that was sectioning off an area of the garage. LPA Ramirez observed a bed with linen, several shoes, and various articles of clothing in bags and boxes. As of 3/7/2024, facility sketch does not indicate garage area is for live-in staff or a staff breakroom. According to Administrator Yamashiro, staff do not live in this area but they rest and may sleep in this area. During annual inspection on 09/21/2023, LPA Maldonado observed a makeshift room for live in staff in the garage. LPA Maldonado requested licensee obtain city permit for room built in garage or demolish room is not permitted by city. Plan of correction (POC) was due by 09/29/2023 and was not cleared. LPA Ramirez will issue deficiency based on observations and records review. Licensee will not use garage area for purposes of live in staff to dwell in garage unless licensee obtains a permit from city or licensee will demolish makeshift room area in garage.

Deficiency being cited today:
87305(a) Alterations to Existing Building or New Facilities-

(a)Prior to construction or alterations, all facilities shall obtain a building permit.

Exit interview was conducted and a copy of this report and appeals rights was provided.
SUPERVISORS NAME: Tony Vasallo
LICENSING EVALUATOR NAME: Kimberly Ramirez
LICENSING EVALUATOR SIGNATURE: DATE: 03/07/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/07/2024
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 03/07/2024 02:04 PM - It Cannot Be Edited


Created By: Kimberly Ramirez On 03/07/2024 at 01:13 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: 03/07/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
03/21/2024
Section Cited
CCR
87305(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.
This requirement was not met as evidence by:
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Licensee will obtain proper city permits for the room built inside the garage, currently used for live-in staff, or demolish the room if not permitted by the city. Proof to be submitted to LPA via email by POC due date. Licensee will submit picture proof by due date of demolished room if unable to obtain permit.
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LPA Ramirez observed a cloth room divider near corner of garage, that was sectioning off an area of the garage. LPA Ramirez observed a bed with linen, several shoes, and various articles of clothing in bags and boxes.
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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:Tony Vasallo
LICENSING EVALUATOR NAME:Kimberly Ramirez
LICENSING EVALUATOR SIGNATURE:
DATE: 03/07/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/07/2024


LIC809 (FAS) - (06/04)
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