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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198603771
Report Date: 05/06/2025
Date Signed: 05/06/2025 11:53:10 AM

Document Has Been Signed on 05/06/2025 11:53 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
MONTEREY PARK ASC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754
FACILITY NAME:WESLEY HEALTH CENTERS-SKID ROW RES CARE FACILITYFACILITY NUMBER:
198603771
ADMINISTRATOR/
DIRECTOR:		VANDERHIDER, DONAHUEFACILITY TYPE:
740
ADDRESS:601 E 5TH STREETTELEPHONE:
(818) 731-4317
CITY:LOS ANGELESSTATE: CAZIP CODE:
90013
CAPACITY: 48CENSUS: 0DATE:
05/06/2025
TYPE OF VISIT:PrelicensingANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:07 AM
MET WITH:Applicant Donahu VanderhiderTIME VISIT/
INSPECTION COMPLETED:
12:00 PM
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Licensing Program Analyst (LPA) Christian Gutierrez conducted a pre-licensing visit. LPA met with Donahu Vanderhider. An initial application was submitted to Community Care Licensing Department (CCLD) for a Residential Care Facility for the Elderly (RCFE) to serve 48 non- ambulatory residents age range 60 and over. The fire clearance has been approved for 48 non-ambulatory. Fire clearance was approved for address 601 E 5th St, Los Angeles, CA 90013 however when LPA arrived, she was informed that the address has changed to 444 S Crocker St, Los Angeles, CA 90013. RO will follow up with CAB. The physical plant was toured with the applicant. Component III was conducted.

The facility is in industrial area and is a three-story building. First floor consists of three (3) staff rooms, staff break room, one (1) staff bathroom, laundry room with multiple washers and dryers, group room for residents, dining area, resident bathrooms, industrial kitchen and medication room. LPA conducted the tour and observed the following: Smoke/fire detectors were observed in common areas. The facility first floor has two (2) bathrooms and were clean and sanitary. There is multiple fire extinguisher located on first floor. All appliances in kitchen were observed to be clean and operational. The sharp knives are located in the kitchen inaccessible to residents. Cleaning supplies and chemicals are stored in a locked cabinet. Medications are locked in medication room. All files will be kept in office. Group room has two computers for residents and lots of game boards and activities. The facility does not have a pool or any large bodies of water. There are cameras only in common areas inside the facility. Next door there is an outdoor area with a dog park that residents can go to.

SEE 809C

NAME OF LICENSING PROGRAM MANAGER: Tony Vasallo
NAME OF LICENSING PROGRAM ANALYST: Christian Gutierrez
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 05/06/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/06/2025
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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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: WESLEY HEALTH CENTERS-SKID ROW RES CARE FACILITY
FACILITY NUMBER: 198603771
VISIT DATE: 05/06/2025
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Second floor consists of eleven (11) shared resident bedrooms, group room, nurse station, bathroom with multiple stalls and eight showers, cleaning supply room, linen closets, and emergency food supply room. LPA conducted the tour and observed the following: Smoke/fire detectors were observed in common areas and in each resident’s bedroom. Residents’ bedrooms were observed to have required furniture such as bed frames, dressers, chairs, lamps, and sufficient closet space. The required bedding was also observed. The facility has one (1) bathroom on this floor with multiple stalls and showers it was clean and sanitary and had required grab bars and grip matts. The water temperate was tested and measured within the required 105-120 degrees. There is multiple fire extinguisher on this floor. Cleaning supplies and chemicals are stored in a locked room. LPA observed extra linen and hygiene supplies. There are cameras only in common areas. LPA observed a working telephone on this floor accessible to residents on this floor.

Third floor consists of thirteen (13) shared resident bedrooms, group room, nurse station, bathroom with multiple stalls and eight showers, cleaning supply room, and linen closets. LPA conducted the tour and observed the following: Smoke/fire detectors were observed in common areas and in each resident’s bedroom. Residents’ bedrooms were observed to have required furniture such as bed frames, dressers, chairs, lamps, and sufficient closet space. The required bedding was also observed. The facility has one (1) bathroom on this floor with multiple stalls and showers it was clean and sanitary and had required grab bars and grip matts. The water temperate was tested and measured within the required 105-120 degrees. There is multiple fire extinguisher on this floor. Cleaning supplies and chemicals are stored in a locked room. LPA observed extra linen and hygiene supplies. There are cameras only in common areas. LPA observed working telephones accessible to residents on this floor.

No records were reviewed since the facility has never been licensed. Per California Code of Regulations, Title 22, the facility meets the physical plant requirements. Component III was conducted with applicant. Exit interview held and a copy of the report was provided to applicant.

NAME OF LICENSING PROGRAM MANAGER: Tony Vasallo
NAME OF LICENSING PROGRAM ANALYST: Christian Gutierrez
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 05/06/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/06/2025
LIC809 (FAS) - (06/04)
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