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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 191801803
Report Date: 10/09/2026
Date Signed: 10/09/2026 03:58:46 PM

Document Has Been Signed on 10/09/2026 03:58 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
MONTEREY PARK ASC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754
FACILITY NAME:GARDEN CRESTFACILITY NUMBER:
191801803
ADMINISTRATOR/
DIRECTOR:		WAYNN-NIETZLE ROMEROFACILITY TYPE:
740
ADDRESS:889 LUCILE AVETELEPHONE:
(323) 663-8281
CITY:LOS ANGELESSTATE: CAZIP CODE:
90026
CAPACITY: 44CENSUS: 21DATE:
10/09/2026
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:29 AM
MET WITH:Mary Anne Villegas, Administrator TIME VISIT/
INSPECTION COMPLETED:
04:03 PM
NARRATIVE
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Licensing Program Analyst (LPA) Alberto Lopez conducted an unannounced annual required visit. LPA met with Karla Yumul Business office manager and discussed the purpose of the visit. Administrator Mary Anne De Jesus Villegas arrived a short time later and assisted with the visit. The purpose of today’s visit was explained. The facility is licensed to serve 44 residents over the age of 60; 18 residents may be non-ambulatory. The facility is approved for 4 hospice waivers, and 6 bedridden in assigned rooms.

Infection Control: Facility has infection control plan and is updated.
Operational Requirements: Facility has liability insurance and operates within the limits of license.
Physical Plant/Environmental Safety LPA took tour with Therese Lu LVN and observed: The facility is a two-story building located in Los Angeles, CA. A tour of the facility includes Upstairs (2nd Floor): 9 resident rooms (with private bathrooms), lobby/TV room, kitchen, dining/activity room, 2 public restrooms, janitor closet and linen closet. Downstair (1st Floor): 13 resident rooms, 2 common shower rooms, beauty shop, library/laundry room, 2 common shower rooms, 2 staff bathrooms, nurse station (medication room), janitor closet and linen closet. Bedrooms were furnished with a bedframe, dresser, lamps, and chairs. LPA observed clean linen, bath towels, and personal hygiene with reasonable closet space available for clients. Signal System was observed in the bedroom and the bathroom. Water temperature was tested and measured between 120.7 to 121.5 which is not in compliance with Title 22 regulations between 105º and 120º F degrees. Carbon monoxide detectors were observed in the hallway on both floors leading to residents’ rooms. Fire extinguishers were observed and were fully charged with last inspection on 02/06/2026. There are shaded areas in front of the facility for residents to enjoy. (continued on 809C)
Lisa Hicks
Alberto Lopez
DATE: 10/09/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/09/2026
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 10/09/2026 03:58 PM - It Cannot Be Edited


Created By: Alberto Lopez On 10/09/2026 at 03:16 PM
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
, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754

FACILITY NAME: GARDEN CREST
FACILITY NUMBER: 191801803

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/09/2026

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
87303(e)(2)
Maintenance and Operation
(2) Faucets used by residents for personal care such as shaving and grooming shall deliver hot water. Hot water temperature controls shall be maintained to automatically regulate the temperature of hot water used by residents to attain a temperature of not less than 105 degree F (41 degrees C) and not more than 120 degree F (49 degrees C).

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, the licensee did not comply with the section cited above. The hot water measured between 120.7 - 121.5 which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 10/19/2026
Plan of Correction
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Administrator will adjust temperature and keep a log for three (3) days with temperature within range of 105.0 to 120.0 degrees F and send to LPA as proof of correction.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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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.
Lisa Hicks
NAME OF LICENSING PROGRAM MANAGER:
Alberto Lopez
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 10/09/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/09/2026


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
MONTEREY PARK ASC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754
FACILITY NAME: GARDEN CREST
FACILITY NUMBER: 191801803
VISIT DATE: 10/09/2026
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(Continued from 809)

Staffing: Facility appears to have enough staff, and all are over 21 years of age.

Personnel Records/Staff Training: Staff record review consisted of Personnel Report, Health Screening, Criminal Record Statements, Fingerprint Clearance, Training, and CPR.
Resident Rights/Information: Resident rights and other required posters were posted at facility,

Planned Activities: Facility has activities for residents to participate in and plenty of room to have them.
Food Service: There is sufficient two (2) days of perishables and seven (7) day supply of non-perishable dehydrated food. Dining room has sufficient seating area. Weekly food menu is posted at the facility. The kitchen staff has modified diets posted for residents that require modified diets.
Incidental Medical and Dental: The medications are centrally stored and locked in the nurse room. The facility uses an electronic Medication Administration Record (MAR) log to document medications given. LPA reviewed medications for (4) residents. PRN are missing labels and PRN authorization letters.

Resident Records/Incident Reports:


Resident record review consisted of Admission Agreements, Identification and Emergency Info, Physicians Report, Consent Report, Need and Service Plans, Personal Rights, and Centrally Store Medication. Needs and appraisal is missing signatures

Disaster Preparedness: Facility has updated emergency disaster plan with three relocation sites. Last fire drill, earthquake, and disaster drill were conducted on 09/15/2026.One relocation site needs to be further away.

Residents with Special Health Needs: No residents have special health needs.

Per California Code of Regulations, Title 22, and California Health and Safety Code, one deficiency was observed during the visit. Technical Violations and Technical Advisory provided. Exit interview was held and a copy of the report was provided Administrator Mary Anne De Jesus Villegas

NAME OF LICENSING PROGRAM MANAGER: Lisa Hicks
NAME OF LICENSING PROGRAM ANALYST: Alberto Lopez
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 10/09/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/09/2026
LIC809 (FAS) - (06/04)
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