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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198603538
Report Date: 09/12/2025
Date Signed: 09/12/2025 04:28:00 PM

Document Has Been Signed on 09/12/2025 04:28 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:ALL IN CAREHOMEFACILITY NUMBER:
198603538
ADMINISTRATOR/
DIRECTOR:		YAMASHIRO, SHELLYFACILITY TYPE:
740
ADDRESS:1158 BEAVER WAYTELEPHONE:
(626) 698-9615
CITY:LA VERNESTATE: CAZIP CODE:
91750
CAPACITY: 6CENSUS: 6DATE:
09/12/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:42 AM
MET WITH:Rathany SuyTIME VISIT/
INSPECTION COMPLETED:
04:15 PM
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Licensing Program Analyst (LPA) Sakinah Madyun conducted an unannounced Required Annual Visit on 09/12/25 using the CARE Inspection tool. LPA was met by Staff #2 Jerome Unica and Staff #3 Gener Gutierrez and explained the purpose of the visit. S2 assisted in the tour of the facility and Administrator Rathay Suy arrived later during the facility tour. The facility is licensed to serve clients of age 18 to 59 years old clients and has a fire clearance approved for six (6) non-ambulatory of which one (1) may be bedridden and approved hospice waiver for three (3) clients. There were one (1) resident under hospice care..

A tour of the single-story facility began at approximately 9:10am that included residents’ rooms: one (1) private staff bedroom, four (4) bedrooms, two (2) bathrooms, living room, dining area, kitchen, backyard, garage/laundry room/storage space.

All residents’ bedrooms have the required furniture for privacy, comfort, and safety. Additional bedding supplies and grooming supplies were observed in the hallway cabinets securely locked. Bedrooms #4 had an exit door. Bathrooms were observed clean and in good repair. Each is in working condition, showers were observed with grab bars and skid mats aside the wall. Water temperature was tested in each bathroom sinks measuring 125.0 degrees F - 125.2 degrees F., which is not within the required 105-120 degrees F.

LPA observed the Infection Control Plan revised 06/26/25 and Emergency Disaster Plan revised 06/26/25. Last documented emergency drill conducted on 06/26/25. First Aid kit observed and (2) Fire Extinguishers were observed and last checked on 06/13/25. Carbon monoxide detector, smoke detectors, and auditory signal systems were in working order located throughout facility. LPA Madyun observed facility sketches with exits and emergency exits routes throughout various locations of the facility. LPA Madyun observed the emergency food supply in kitchen cabinet.

LIC 809C for continuation of report.

NAME OF LICENSING PROGRAM MANAGER: Lisa Hicks
NAME OF LICENSING PROGRAM ANALYST: Sakinah Madyun
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 09/12/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/12/2025
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: ALL IN CAREHOME
FACILITY NUMBER: 198603538
VISIT DATE: 09/12/2025
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LPA observed the front and backyard to be clean and well maintained without any hazards. Due to windy weather conditions the provided shade covering was destroyed.

The kitchen is in good repair, dishes and utensils were observed, the cabinets are used to store items for cooking. Refrigerators were observed clean and in good repair. Food supplies were observed for at least 2 days of perishables and 7 days of non-perishables. Water temperature was tested in the kitchen sink measuring 125.0 degrees F - 125.2 degrees F., which is not within the required 105-120 degrees F.

The Laundry area was observed in the garage with locking cabinets for items that are inaccessible to clients. Licensing posters, Let us Know (PUB 745) and clients' personal rights were observed on a board in the kitchen/dining area.

No large bodies of water were observed LPA Madyun observed signs posted indicating “No smoking - Oxygen in Use” in various locations of the facility. LPA Madyun observed several oxygen tanks in resident rooms secured in stands. Knives, sharps or other items that could pose a danger to residents with dementia, were observed to be inaccessible.

The medications are centrally stored in the medication cabinet securely locked and in bubble packs and/or original containers. The facility uses the Medication Administration Record (MAR) log to document medications given. Resident files are maintained at the facility. LPA reviewed two (2) of six (6) clients medication logs. Due to time constraint LPA will return a later date and time for a continuation visit and conduct client interviews and review files and medication logs.



Administrator Certificate for Shelly Yamashiro #7014120740 expires 10/05/27. Staff employed are over the age of 18 and are fingerprint cleared and associated to the facility. Staff are cleaning and disinfecting often for high touched surfaces. Facility has an Infection Control Plan in place.

Staff files are maintained at the facility. LPA Madyun observed required annual training, CPR and First Aid for seven (7) out of the seven (7) personnel records reviewed. LPA Madyun observed TB testing results, Health screening, fingerprint clearance and job application for seven (7) out of the seven (7) personnel records reviewed. Due to time constraint LPA will return a later date and time for a continuation visit and conduct staff interviews.

The following deficiency were cited according to The State of California Regulatory Codes, Title 22, Div. 6, Chapter 1(refer to Lic 809D).

Exit interview conducted with Shelly Yamashiro and a copy of this report was provided.

NAME OF LICENSING PROGRAM MANAGER: Lisa Hicks
NAME OF LICENSING PROGRAM ANALYST: Sakinah Madyun
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 09/12/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/12/2025
LIC809 (FAS) - (06/04)
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