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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198603969
Report Date: 04/30/2026
Date Signed: 04/30/2026 11:45:43 AM

Document Has Been Signed on 04/30/2026 11:45 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
GREATER LA AC/SC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754
FACILITY NAME:LOVING HANDS ASSISTED CAREFACILITY NUMBER:
198603969
ADMINISTRATOR/
DIRECTOR:		MARANTAL CARRILLO, ROWENAFACILITY TYPE:
740
ADDRESS:10410 BELLMAN AVETELEPHONE:
(212) 281-1439
CITY:DOWNEYSTATE: CAZIP CODE:
90241
CAPACITY: 6CENSUS: 0DATE:
04/30/2026
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:12 AM
MET WITH:Rowena Carrillo - AdministratorTIME VISIT/
INSPECTION COMPLETED:
11:50 AM
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Licensing Program Analyst (LPA) Tena Herrera conducted an announced pre-licensing visit and met with Administrator Rowena Carrillo and Licensee Jon Gardea. The purpose of todays visit is to conduct a Pre-Licensing Inspection / Component III visit. The facility has an approved fire clearance to be licensed to serve 1 Bedridden and 5 Non-Ambulatory Residents ages 60 and above.

The facility is a single story home located in Downey, CA, a tour of the facility includes: 4 bedrooms (2 of which are shared bedrooms), 2 bathrooms, dining room, living room, kitchen, front yard/back yard, detached garage with laundry area. There is an ADU detached from the facility where the licensee intends to live, residents will not have access to this ADU.

The physical plant was toured and the following was observed/inspected:

· Bedrooms are equipped with bed, night-stand, chair, sufficient lighting, closet and drawer space.


· All beds had the required linen/supplies which include, pillowcase, mattress pads, fitted sheet, blanket and bedspreads. Mattresses and bedsprings are in good repair.
· Bedrooms are large enough to allow for easy passage between and comfortable for usage of beds and other required items of furniture.
· Sufficient supply of personal hygiene items and linens are available and are stored in storage cabinet.
· Laundry machine (wash/dryer) observed and is located in the detached garage.
· The 2 bathrooms have a working toilet, wash basin, shower, the required grab bars and non-slip mats.
· Smoke Detectors and Carbon monoxide detectors were observed and operable.
· Fire extinguishers observed and fully charged.
(Continued on LIC809-C)
NAME OF LICENSING PROGRAM MANAGER: David Sicairos
NAME OF LICENSING PROGRAM ANALYST: Tena Herrera
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 04/30/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/30/2026
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 3
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
GREATER LA AC/SC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754
FACILITY NAME: LOVING HANDS ASSISTED CARE
FACILITY NUMBER: 198603969
VISIT DATE: 04/30/2026
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· Cleaning solutions and sharps are securely locked in kitchen.
· Kitchen cabinets, refrigerator/freezer, oven, microwave, dishwasher are in working condition, clean and sanitary. Sufficient food supply was observed along with emergency food supply.
· Sufficient dishes, cups, and silverware are readily available and in good repair
· Dining area is fully furnished for 6 individuals.
· There is a designated space for Medications that is locked.
· Client and Staff files will be stored in a locked cabinet.
· First Aid Kit and manual was observed.
· Building and grounds are free from hazards. Window screens are in good condition.
· There is a shaded area provided in the backyard.
· Hot water temperature measured and was within the required range of 105-120 degrees F.
· The residence is equipped with central air and heating, temperature remains at a comfortable temperature.
· Facility phone line was tested and is operable, facility number: 562-441-8446.
· Licensee reports no guns, weapons or ammunition will be stored in the facility.
· Emergency Disaster Plan was observed and will be posted prior to admitting residents
· Both Administrator Rowena and Licensee Jon maintain a valid administrator certificate.
· The facility does not have the required liability insurance yet, however, Administrator confirmed they will have insurance prior to admitting any residents.
· Resident Rights, Complaint, and Ombudsman Posters were observed posted in the living room area.
· Facility has a variety of activities and games stored in a cabinet

*there is work being done behind the ADU, licensee is having a private patio area added, licensee confirmed that area that will be inaccessible to residents and work will be completed by 5/8/26, residents will not be admitted until after work is complete*

LPA is also clarifying with the fire department and CAB regarding which room is approved for bedridden.

Component III was completed during todays visit and reviewed by Licensee and Administrator.

An exit interview was conducted, and a copy of this report was provided. Accordingly, LPA will submit a copy of this facility evaluation report to the Central Applications Bureau (CAB) for review. If the applicant has questions regarding the status of the application, they have been instructed to communicate with the CAB Analyst assigned to their application.

NAME OF LICENSING PROGRAM MANAGER: David Sicairos
NAME OF LICENSING PROGRAM ANALYST: Tena Herrera
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 04/30/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/30/2026
LIC809 (FAS) - (06/04)
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