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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 421703870
Report Date: 07/17/2025
Date Signed: 07/17/2025 10:52:40 AM

Document Has Been Signed on 07/17/2025 10:52 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
CCLD Regional Office, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364
FACILITY NAME:MARSH'S BOARD & CAREFACILITY NUMBER:
421703870
ADMINISTRATOR/
DIRECTOR:		MARSH,SUSAN 98FACILITY TYPE:
740
ADDRESS:233 ALDEBARAN AVENUETELEPHONE:
(805) 733-2231
CITY:LOMPOCSTATE: CAZIP CODE:
93436
CAPACITY: 5CENSUS: 1DATE:
07/17/2025
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:00 AM
MET WITH:Administrator, Susan MarshTIME VISIT/
INSPECTION COMPLETED:
11:14 AM
NARRATIVE
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 At 9:00am on 07/17/2025, Licensing Program Analyst (LPA) Jeffries arrived unannounced to the facility to conduct a case management visit pertaining to Tri Counties Regional Center (TCRC) facility visit on 07/01/2025, where a rodent was observed and photographed in the facility kitchen. LPA was accompanied by TCRC, Adela Cortinas (QA1), who announce who they are and the reason for the visit. On 07/14/2025 LPA contacted the Administrator by phone and provided local pest control companies who verified by phone that they do rodent abatement. The Administrator requested that LPA email that information to the Administrator and LPA did so on 07/14/2025 with pest control companies contact information and a request that Administrator call one of them as soon as possible in order to abate rodents from facility. On 07/17/2025, QA1 and LPA observed a rat head poking out a hole below the kitchen cabinets, Administrator, QA1 and LPA heard rat scratching, and Q1 and LPA heard rat crying sound during case management visit. Based on this case management visit observations and photographic evidence with reliable witnesses on the TCRC 07/01/2025 visit of the presents of rodents in the facility, LPA Jeffries issued a citation under regulations 87555(b)(27) General Food Requirements, that all kitchen areas shall be kept clean and free of litter, rodents, vermin, and insects.

Additionally, on 07/01/2025, TCRC QA2 reported to LPA that the kitchen presented a strong “ammonia” smell. During this case management visit, On 07/17/2025, QA1 and LPA both noted a strong “ammonia” smell when walking through the entrance of the facility, which is the living room and continued through the dining room and into the facility kitchen area. There are two holes and an empty space where the dishwasher was in the past. These observations resulted in a citation of 87303(f) Maintenance and Operations all waste shall be located, stored, and disposed of a manner that will not transmit … orders, pose a risk to health and safety, or provide a breeding place for food source for insects or rodents. LPA issued two citations as a result of this case management visit. Exit interview, report read, citations issue, appeal rights and report provided.

NAME OF LICENSING PROGRAM MANAGER: Kelly Burley
NAME OF LICENSING PROGRAM ANALYST: Mark Jeffries
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 07/16/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/16/2025
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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Document Has Been Signed on 07/17/2025 10:52 AM - It Cannot Be Edited


Created By: Mark Jeffries On 07/16/2025 at 10:32 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
, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364

FACILITY NAME: MARSH'S BOARD & CARE
FACILITY NUMBER: 421703870

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/17/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
07/18/2025
Section Cited
CCR
8755(b)(27)

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87555(b)(27) General Food Requirements (b) The following food service requirements shall apply: (27) All kitchen areas shall be kept clean and free of litter, rodents, vermin and insects. This requirement was not met by evidence of rodents observed in the facility kitchen, which poses an eminent
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Administrator agreed to contact Pest Control Company to employed them to abate the rats observed in the kitchen. Administrator will send a copy of the BIll for the exact services provided. By 07/18/2025.
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 risk to residents in care.
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Type B
07/31/2025
Section Cited
CCR87303(f)

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87303(f) Maintenance and Operation (f) All waste shall be located, stored, and disposed of in a manner that will not transmit communicable diseases or odors, pose a risk to health and safety, or provide a breeding place or food source for insects or rodents. This requirement was not met
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Administrator agreed to have employed staff help to clean facility to elevate "ammonia" smell out of facility. LPA will conduct a case management visit on or after 14 days of this citation to confirm smell is abated from facility.
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by evidence of “ammonia” odor present in facility, which poses a potential risk to residents in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Kelly Burley
NAME OF LICENSING PROGRAM MANAGER:
Mark Jeffries
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 07/16/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/16/2025


LIC809 (FAS) - (06/04)
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