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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198603623
Report Date: 02/21/2025
Date Signed: 02/24/2025 08:14:31 AM

Document Has Been Signed on 02/24/2025 08:14 AM - 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:LOVING ARMS RESIDENTIAL CARE FOR SENIOR IIIFACILITY NUMBER:
198603623
ADMINISTRATOR/
DIRECTOR:		BISNAR, LOURDESFACILITY TYPE:
740
ADDRESS:11511 THOMAS PLACETELEPHONE:
5628646308
CITY:NORWALKSTATE: CAZIP CODE:
90650
CAPACITY: 6CENSUS: 5DATE:
02/21/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:20 AM
MET WITH:Lourdes BisnarTIME VISIT/
INSPECTION COMPLETED:
12:50 PM
NARRATIVE
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Licensing Program Analyst (LPA) Nicol Wesley conducted an unannounced Required 1 Year visit at the facility and met with Administrator Lourdes Bisnar.
The facility is licensed to serve age range 60 and over. Bedrooms 1,2,3 approved for non ambulatory. Bedroom #4 approved for Bedridden. Hospice waiver approved for six(6) residents.
LPA Wesley conducted a complete tour of the facility and utilized the Compliance and Regulatory Enforcement (CARE) tools for the todays visit. LPA observed the supply of food, Resident medications, and medication logs were reviewed. The smoke detectors/carbon monoxide detector are operable. LPA Wesley observed the fire extinguisher in the kitchen area to be fully charged and serviced. The water temperature was tested and measured 116.6 degrees F. The Last fire drill was conducted on 12/04/24. LPA Wesley interviewed 2 residents and 2 staff. The smoke detectors/carbon monoxide detector are operable. The Liability insurance is current expires on 04/26/25. The Administrators certificate for Lourdes Bisnar Certificate 7005767740 expires 8/9/26.

There is one citation cited in accordance to the California Code of Regulations, Title 22.

Exit interview conducted, and a copy of the report was given to Lourdes Bisnar.
SUPERVISORS NAME: Lisa Hicks
LICENSING EVALUATOR NAME: Nicol Wesley
LICENSING EVALUATOR SIGNATURE: DATE: 02/21/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/21/2025
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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Document Has Been Signed on 02/24/2025 08:14 AM - It Cannot Be Edited


Created By: Nicol Wesley On 02/21/2025 at 11:27 AM
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: LOVING ARMS RESIDENTIAL CARE FOR SENIOR III
FACILITY NUMBER: 198603623

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/21/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
87303(a)

Maintenance and Operation
This requirement is not met as evidenced by: when LPA tried to enter the facility through the entrance gate, there was an overgowth of lawn and pavement pushed up, not allowing me to enter into the facility.
Deficient Practice Statement
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Based on the LPA's observation, the licensee did not comply with the section cited above, which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 03/21/2025
Plan of Correction
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The Licensee or Administrator shall have the entrance to the facility repaired by POC 03/21/25 and send POC to 323 980 4912 Attn: Nicol Wesley
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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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:Lisa Hicks
LICENSING EVALUATOR NAME:Nicol Wesley
LICENSING EVALUATOR SIGNATURE:
DATE: 02/21/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/21/2025


LIC809 (FAS) - (06/04)
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