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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306006707
Report Date: 07/01/2025
Date Signed: 07/01/2025 11:20:39 AM

Document Has Been Signed on 07/01/2025 11:20 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
ORANGE COUNTY RO, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME:BEST SENIOR CAREFACILITY NUMBER:
306006707
ADMINISTRATOR/
DIRECTOR:		REROMA, STEVELYNFACILITY TYPE:
740
ADDRESS:17912 LINCOLN ST.TELEPHONE:
(818) 633-0211
CITY:VILLA PARKSTATE: CAZIP CODE:
92867
CAPACITY: 6CENSUS: 5DATE:
07/01/2025
TYPE OF VISIT:PrelicensingANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:30 AM
MET WITH:Stevelyn ReromaTIME VISIT/
INSPECTION COMPLETED:
11:30 AM
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Licensing Program Analyst (LPA) William Vanegas made an announced visit for the purposes of conducting the pre-licensing inspection for a change in ownership of the facility. LPA Vanegas met with previous owner Mariana Nita and new owner Stevelyn Reroma. LPA Vanegas began a tour of the facility and observed the following.

Structure:
This facility is a two storied home with 10 rooms 6 rooms are private resident rooms located on the first floor of the facility. There are 4 additional rooms located on the second floor, however 3 rooms are staff rooms, and 1 room is used for storage. The facility has 4 and a half bathrooms. 3 are for resident use, and and 1 is for staff and visitors. The facility also consists of an attached three car garage. LPA Vanegas observed a washer and dryer, refrigerator, microwave, and electric stove all in good repair, and tested operational. There is an outdoor shaded sitting area, and a fully fenced pool in the backyard, with the fence measuring 4ft, 3in tall, and the gaps between the fence are 4 inches. Side doors along exit rout of the facility are self latching and unlocked.

Food Services:
Seven day supply of non-perishable food is available for residents in care. Two day supply of perishable food was observed to be in the kitchen area, and a sufficient amount of emergency water was available for residents in care as well.

Smoke and Carbon Monoxide Detectors:
All carbon monoxide and smoke detectors were tested to be operational and in good repair.
CONTINUED ON LIC809C
NAME OF LICENSING PROGRAM MANAGER: Armando J Lucero
NAME OF LICENSING PROGRAM ANALYST: William Vanegas
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 07/01/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/01/2025
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)
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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
ORANGE COUNTY RO, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME: BEST SENIOR CARE
FACILITY NUMBER: 306006707
VISIT DATE: 07/01/2025
NARRATIVE
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Fire Extinguishers:
All fire extinguishers were mounted, fully charged, and scheduled to be serviced on July 19, 2025.

Fire Clearance:
Approved on March 11, 2025 for 6 non-ambulatory clients.

Toxins and Sharps:
Cleaning supplies, toxins, and sharps were observed to be secured and inaccessible

Water Temperature:
The hot water temperature measured at 116.4-117.2 in the client bathrooms and 115.8-116.2 degrees Fahrenheit in the staff bathrooms.

Medications, First Aid Kit, & Manual:
The First Aid Kit was observed to have all required items such as adhesive tape, bandages, scissors, tweezers, and a thermometer. The manual was also available.

Signal System:


No signal system.

Bedrooms:
The client bedrooms had all required components, are spacious, and easily accommodates furnishings.

Bathrooms: Bathrooms were operational and slip resistant mats were present. Facility will deep clean all bathrooms and install locks on all client bathrooms.

Linens and Hygiene Supplies:
Clean linens and hygiene supplies were observed to be fully stocked.

CONTINUED ON LIC809C
NAME OF LICENSING PROGRAM MANAGER: Armando J Lucero
NAME OF LICENSING PROGRAM ANALYST: William Vanegas
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 07/01/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/01/2025
LIC809 (FAS) - (06/04)
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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
ORANGE COUNTY RO, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME: BEST SENIOR CARE
FACILITY NUMBER: 306006707
VISIT DATE: 07/01/2025
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Resident and Staff Files:
Client and staff records are maintained on site and available for the Department's inspection.

Reading Material, Games, Equipment, & Materials:
The facility maintains games and activities in the living room area and closet.

Emergency Phone Numbers/Exit Plan:
Posted on the bulletin board by the entry way.

Postings:
The See Something, Say Something (PUB475), the Rights of the Resident Councils, Resident's Rights, were posted in the entry way. A copy of the Admission Agreement is available at the facility upon request.

Component III:
Component three Orientation was waived with Applicant Stevelyn Reroma because of Change of Ownership, and applicant is currently working with same clients and previous owner.

The pre-licensing visit is now complete. The facility meets the requirements for licensure. LPA Vanegas will forward this report to the Centralized Applications Bureau for review. The license will be granted upon completion of a final review and approval from the Centralized Applications Bureau.

Exit interview was conducted and a copy of this report was left with Applicant Sevelyn Reroma.
NAME OF LICENSING PROGRAM MANAGER: Armando J Lucero
NAME OF LICENSING PROGRAM ANALYST: William Vanegas
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 07/01/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/01/2025
LIC809 (FAS) - (06/04)
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