<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306003441
Report Date: 12/22/2025
Date Signed: 12/22/2025 01:50:20 PM

Document Has Been Signed on 12/22/2025 01:50 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
CCLD Regional Office, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME:WHITTIER COTTAGEFACILITY NUMBER:
306003441
ADMINISTRATOR/
DIRECTOR:		BOHANAN-TRAZO, VILMAFACILITY TYPE:
740
ADDRESS:710 RYE AVENUETELEPHONE:
(714) 449-0209
CITY:LA HABRASTATE: CAZIP CODE:
90631
CAPACITY: 6CENSUS: 4DATE:
12/22/2025
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
07:35 AM
MET WITH:James TrazoTIME VISIT/
INSPECTION COMPLETED:
02:05 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
This unannounced Case Management – Incident inspection is being conducted by Licensing Program Analyst (LPA) Sean Haddad for the purpose of following up on a self-reported incident report received in the Orange County Regional Office (OCRO) on December 15, 2025, regarding Resident #1 (R1). LPA met with Administrator (AD) James Trazo and explained the reason for today’s inspection. During today’s inspection, LPA inspected the facility, interviewed AD and witnesses, and requested and reviewed copies of the resident roster, staff roster, and resident files. Per the incident report received in the OCRO on December 15, 2025, on December 13, 2025, R1 was taken via medical transport to a routine doctor’s appointment at 7:00AM, refused to return to the facility after the appointment was over, is now missing, and local law enforcement and R1’s family were notified. LPA inspected the facility, conducted health and safety checks on residents present, and observed no health and safety issues. LPA reviewed R1’s Physician’s Report dated November 21, 2025, which indicates R1 does not have Dementia or Mild Cognitive Impairment, R1 is not able to leave the facility unassisted because R1 is “bedbound”, R1 is bedridden, and R1’s ambulatory status is based only on physical condition. Per a letter from R1’s medical provider, R1 was placed at the facility on November 21, 2025. LPA interviewed AD who stated that R1 had always previously gone to these daily doctor’s appointments with their family as their family transported them there, this was the first time R1 went by themselves via medical transport without their family, and after the appointment was over R1 refused to return to the facility with the medical transport. LPA reviewed a communication from the medical transport confirming that R1 refused to return to the facility and had signed documentation confirming their refusal. Per AD, staff at the doctor’s office observed R1 leaving with someone, R1’s family and local law enforcement were notified immediately, and law enforcement documented the case as a voluntary missing person.
NAME OF LICENSING PROGRAM MANAGER: Armando J Lucero
NAME OF LICENSING PROGRAM ANALYST: Sean Haddad
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 12/22/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/22/2025
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 4
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)
Page: 2 of 4
Document Has Been Signed on 12/22/2025 01:50 PM - It Cannot Be Edited


Created By: Sean Haddad On 12/22/2025 at 11:18 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
, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868

FACILITY NAME: WHITTIER COTTAGE
FACILITY NUMBER: 306003441

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/22/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
12/23/2025
Section Cited
CCR
87464(f)(1)

1
2
3
4
5
6
7
87464 Basic Services … (f) Basic services shall at a minimum include: (1) Care and supervision. This requirement was not met as evidenced by:
1
2
3
4
5
6
7
Licensee stated they will retrain staff on residents’ ability to leave the facility unassisted and will continue to follow up with R1’s status and provide updates to LPA.
8
9
10
11
12
13
14
Based on interviews and documents, the licensee did not ensure R1 received care and supervision to meet their needs when they were unsupervised at their doctor’s appointment and decided not to return to the facility, which poses an immediate safety risk to persons in care.
8
9
10
11
12
13
14
Type B
12/29/2025
Section Cited
CCR87506(a)

1
2
3
4
5
6
7
87506 Resident Records (a) The licensee shall ensure that a separate, complete, and current record is maintained for each resident in the facility … This requirement was not met as evidenced by:
1
2
3
4
5
6
7
Licensee stated they will create a protocol for completing resident files prior to admission and submit proof to LPA by POC due date.
8
9
10
11
12
13
14
Based on admission and documents, the licensee did not have a complete resident file for R1, which poses potential safety risk to persons in care.
8
9
10
11
12
13
14
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Armando J Lucero
NAME OF LICENSING PROGRAM MANAGER:
Sean Haddad
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 12/22/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/22/2025


LIC809 (FAS) - (06/04)
Page: 3 of 4
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME: WHITTIER COTTAGE
FACILITY NUMBER: 306003441
VISIT DATE: 12/22/2025
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
AD stated that staff at the doctor’s office noted that R1 did not want to reside at the facility and AD believes that, when R1’s family did not accompany them during this appointment, R1 took the opportunity to not return to the facility. Per AD, R1’s family reported that a family friend saw R1 after they went missing, but for unknown reasons R1 was not returned to the facility, and R1’s family also reported that a police officer had made contact with R1, R1 is doing well, and R1’s family has a general idea of where R1 is and is planning to try to convince R1 to return to the facility or go to the hospital. LPA made contact with R1’s family, but was unable to obtain information from R1’s family. LPA interviewed the La Habra Police Detective overseeing R1’s case who stated that R1 had lied and said they were being picked up from the doctor’s appointment by their family, but had actually coordinated with someone who met them at the doctor’s office to wheel them out in their wheelchair, R1 was found in Whittier and is living on the streets by choice, R1 does not want to return to the facility, R1 is able to make their own decisions and has no cognitive issues or court orders that would allow law enforcement to further intervene, and the case has been closed. LPA interviewed staff at R1’s doctor’s office who confirmed the details of the incident and stated that R1 actually returned to the office on December 16, 2025, but has not returned since. Per AD, the facility did not purposefully send R1 to the doctor’s appointment without supervision and believed R1’s family would meet them at the appointment. However, it was still the facility’s responsible to ensure R1 was supervised at all times, as R1 is unable to leave the facility unassisted, and in this case R1 was unsupervised while on the medical transport, as the communication from the medical transport indicates the transport personnel do not have a duty to supervise passengers and would allow passengers to exit any time during transit, and R1 was unsupervised at the doctor’s office. In addition, this was the first day R1 was taking medical transport to their daily doctor’s appointments, as opposed to being transported by their family, and the facility needed to confirm with R1’s family that they would meet R1 at the appointment and it appears there may have been some miscommunication. Based on the information obtained, R1 is no longer a resident of the facility after refusing to return and choosing to make alternative living arrangements as R1 had the capacity to make those decisions. AD stated that R1’s placement agency terminated R1’s placement at the facility the day R1 left. LPA noted R1’s file was not present at the facility. Per AD, R1 took the paperwork with them to complete it with their family and that is why it is not present. Based on this information, the facility did not maintain a file for R1 as it is not present at the facility and it was not complete.Based on the information obtained during today’s inspection, deficiencies are being cited per Title 22 Division 6 of the California Code of Regulations. See LIC809D. An exit interview was conducted and a copy of this report and appeal rights was discussed with and provided to facility representative.
NAME OF LICENSING PROGRAM MANAGER: Armando J Lucero
NAME OF LICENSING PROGRAM ANALYST: Sean Haddad
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 12/22/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/22/2025
LIC809 (FAS) - (06/04)
Page: 4 of 4