198603782-10-23-2025-28-AS-DKOI-DMQN7C-20251023101232

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 198603782
Report Date: 10/23/2025
Date Signed: 10/23/2025 10:13:10 AM

Document Has Been Signed on 10/23/2025 10:13 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:	GALAXY CARE HOME		FACILITY NUMBER:	198603782
ADMINISTRATOR/ DIRECTOR:	MARALLI-TAMAYO, EMMA		FACILITY TYPE:	740
ADDRESS:	12802 CURTIS AND KING ROAD		TELEPHONE:	(949) 247-4879
CITY:	NORWALK	STATE: CA	ZIP CODE:	90650
CAPACITY: 6		CENSUS: 4	DATE:	10/23/2025
TYPE OF VISIT:	Prelicensing	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	09:51 AM
MET WITH:	Emma Maralli-Tamayo, Applicant Designee		TIME VISIT/ INSPECTION COMPLETED:	10:20 AM

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Licensing Program Analyst (LPA) Daniel Konishi made an announced follow up visit and met with the applicant designee Emma Maralli-Tamayo to conduct an announced Pre-Licensing evaluation.

During the initial pre-licensing visit conducted on 07/01/2025, the following items required follow up/corrections:

1. Resubmit your current facility sketch.(The other one doesn't reflect what is being shown

2. The kitchen cabinets are in need of replacing in the resident kitchen and the staff kitchen.

3. The counter top in the kitchen is in need of replacing/repairing.

4. The family room couches are in need of replacing, or repairing the cushions(filled).

5. Make the family room look liveable like the living room on the other side

6. Clean the ceiling fan in kitchen 2 (staff).

7. Bedroom #4 mattress is in need of replacing.

8. Cut all of the trees obstructing the passage/walk ways.

9. Remove debris from yard(doors, wood, shower chairs, razor, wooden pallet, screen doors).

NAME OF LICENSING PROGRAM MANAGER: David Sicairos
NAME OF LICENSING PROGRAM ANALYST: Daniel Konishi
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 10/23/2025

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/23/2025

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: GALAXY CARE HOME	FACILITY NUMBER: 198603782
	VISIT DATE: 10/23/2025

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During today’s visit LPA observed the following corrections:

1. Resubmit your current facility sketch.(The other one doesn't reflect what is being shown) – LPA received updated facility sketch that shows the current facility layout via email on 10/09/2025. – cleared.

2. The kitchen cabinets are in need of replacing in the resident kitchen and the staff kitchen. – LPA toured facility and observed the kitchen cabinets have been replaced. – cleared.

3. The counter top in the kitchen is in need of replacing/repairing. - LPA toured facility and observed the counter top in the kitchen have been replaced. – cleared.

4. The family room couches are in need of replacing, or repairing the cushions(filled). – LPA observed new couch with new cushions. – cleared.

5. Make the family room look liveable like the living room on the other side – LPA observed family room and observed it to be cleaned, neat, and in good repair. – cleared.

6. Clean the ceiling fan in kitchen 2 (staff). – LPA toured kitchen and observed ceiling fan is clean. – cleared.

7. Bedroom #4 mattress is in need of replacing. – LPA toured bathroom #4 and observed the new mattress that is in good, clean, working condition. – cleared.

8. Cut all of the trees obstructing the passage/walk ways. – LPA toured facility and observed that all these items have been cleaned and passage/walk ways are clear. – cleared.

9. Remove debris from yard(doors, wood, shower chairs, razor, wooden pallet, screen doors). – LPA toured facility and observed no debris from the yard. – cleared.

Pre-Licensing is complete, and there are no additional items that require follow-up. Exit interview was conducted with the applicant designee, Emma Maralli-Tamayo and a copy of this report was provided.

NAME OF LICENSING PROGRAM MANAGER: David Sicairos
NAME OF LICENSING PROGRAM ANALYST: Daniel Konishi
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 10/23/2025

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/23/2025

LIC809 (FAS) - (06/04)

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