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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 421703870
Report Date: 08/08/2025
Date Signed: 08/08/2025 12:58:19 PM

Document Has Been Signed on 08/08/2025 12:58 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, 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:
08/08/2025
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:49 AM
MET WITH:Administrator, Susan MarshTIME VISIT/
INSPECTION COMPLETED:
11:50 AM
NARRATIVE
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 At 10:00am on 08/08/2025, Licensing Program Analyst (LPA) Jeffries arrived unannounced to the facility to conduct a case management visit pertaining a follow up visit from the Case Management visit on 07/17/2025. from a Tri Counties Regional Center (TCRC) facility visit on 07/01/2025, where a rodent was observed and photographed in the facility kitchen. LPA announced who they are and the reason for the visit. LPA to ascertain if the facility followed the plan of corrections from the deficiency dated 07/18/2025, extermination of rodents. On 08/04/2025, LPA and Tri Counties Regional Center (TCRC), Adela Cortinas (QA), conducted a case management visit to ascertain two violations issued on 07/18/2025. The type B violation of eliminating “ammonia” odor was cleared, however the Administrator had not been successful in employing appropriate rodent abetment contractor. On the case management visit of 08/04/2025, the Administrator stated that they had employed a general contractor, who cleaned out "area with liquid cleaner, wet/dry vacuumed areas, bought and placed traps and cleaned out attic and set traps. During the case management visit QA and LPA saw more than two different rodents on the floor in the kitchen area. On 07/14/2025 LPA sent email to Administrator with contact information of 4 approved rodent abetment contractors that serviced the area of this facility. On 07/22/2025 LPA sent an email for Administrator to have Structural Pest Control Board (SPCB) certification to conduct pest control abatement. On the case management visit on 08/04/2025, Administrator stated that they had difficulty with one of the contractors on the list provided by LPA. On the case management visit of 08/04/2025, due to the difficulty administrator stated having with the rodent abatement contractor that was called from the list LPA provided, LPA provided an extension. Administrator agreed to call the appropriate pest control abatement service in the next 24 hours (08/04/2028) and schedule the next available appointment.

CONTINUED on LIC809-C

NAME OF LICENSING PROGRAM MANAGER: Kelly Burley
NAME OF LICENSING PROGRAM ANALYST: Mark Jeffries
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 08/08/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/08/2025
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
CCLD Regional Office, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364
FACILITY NAME: MARSH'S BOARD & CARE
FACILITY NUMBER: 421703870
VISIT DATE: 08/08/2025
NARRATIVE
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 On 08/04/2025, LPA emailed 4 additional contractors that were qualified to conduct rodent abetment in the area of the facility, LPA followed up with a call letting Administrator know of the email was in their email in box with 4 new rodent abatement contractors. Administrator returned response email with the following: “Thanks Mark. So currently I’ve been in contact once again with Justin Clegg dba “ Justin-n-Time” who will come with appropriate documents to satisfy CCL. And meanwhile I will keep working on house as usual. Susan Marsh Sent from my iPhone” On 08/07/2025, LPA contacted Justin Clegg of Just-n-time concrete, who stated that they have not received any calls for rodent abatement and have nothing scheduled for rodent abatement. Mr. Clegg further explained that they are a concrete contractor and don’t do rodent abatement unless it is specifically for concrete work. Based on the information the Administrator has not followed the Plan of Correction for the Type A citation that was written on 07/17/2025. At this time a civil penalty will be assessed for repeat violation, due to the eminent danger, the present of rodents’in place on residents in care. The plan of corrections still remains as a priority for the Administrator to employ the proper contractor to conduct rodent abatement services at the facility until there is formal verification by the abatement company that the rodent infestation has been eliminated by showing monthly invoices of rodent abatement services.

Exit interview, report read, civil penalty issued, appeal rights and report provided.

NAME OF LICENSING PROGRAM MANAGER: Kelly Burley
NAME OF LICENSING PROGRAM ANALYST: Mark Jeffries
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 08/08/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/08/2025
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 08/08/2025 12:58 PM - It Cannot Be Edited


Created By: Mark Jeffries On 08/08/2025 at 07:39 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: 08/08/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
08/11/2025
Section Cited
CCR
87555(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 risk to
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Administrator agreed to contact Pest Control Company, certificated for rodent abatement by the end of this business day (08/08/2025) to employ them to abate the rats observed in the kitchen immediately (soonest appointment available). Administrator will contact LPA as to the time and date of
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residents in care.
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the schedule and additionally, send a copy of the Bill for the exact services provided on a monthly basis until Pest Control confirms by documentation that rodents have been eliminated from the facility.

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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: 08/08/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/08/2025


LIC809 (FAS) - (06/04)
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