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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198320424
Report Date: 08/26/2026
Date Signed: 08/26/2026 04:28:36 PM


COMPREHENSIVE INSPECTION

Document Has Been Signed on 08/26/2026 04:28 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
EL SEGUNDO ASC, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245
FACILITY NAME:HAPPY LIFE ELDER CAREFACILITY NUMBER:
198320424
ADMINISTRATOR/
DIRECTOR:		DIONISIO, ANTONIA E.FACILITY TYPE:
740
ADDRESS:22002 NEPTUNE AVENUETELEPHONE:
(310) 435-5820
CITY:CARSONSTATE: CAZIP CODE:
90745
CAPACITY: 6CENSUS: 6DATE:
08/26/2026
TYPE OF VISIT:Case Management - Annual ContinuationUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
02:00 PM
MET WITH:Antonia DionisioTIME VISIT/
INSPECTION COMPLETED:
04:45 PM
NARRATIVE
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On 08/26/2026 at approximately 2:00PM, Licensing Program Analyst (LPA) Jose Anguiano conducted an unannounced continuation annual visit to complete the required annual inspection initiated on 08/20/2026. LPA met with Licensee/Administrator Antonia Dionisio and explained the purpose of today’s visit.

During today’s visit, LPA continued the inspection of the physical plant and reviewed resident and staff records. LPA reviewed all six (6) resident Medication Administration Records (MARs). Medications were reviewed and no discrepancies were observed at the time of visit. LPA reviewed (2) staff records and six (6) resident records with no discrepancies.

Upon arrival, LPA observed one (1) staff member providing care and supervision to six (6) elderly residents, several of whom per caregiver require assistance with activities of daily living.

LPA observed cleaning chemicals/disinfectants stored in an unlocked kitchen drawer accessible to residents. LPA also observed cockroaches inside kitchen drawers, excessive clutter and numerous boxes stored in the garage, and a metal bed frame, electrical bed equipment, and trash stored in the backyard area.

LPA inspected/tested the facility's smoke and carbon monoxide detectors and were operational and in good repair.

Deficiencies are being cited pursuant to the California Code of Regulations, Title 22, Division 6, Chapter 8. Refer to the attached (LIC 809-D’s) for additional information and Plans of Correction.

An exit interview was conducted with Licensee/Administrator Antonia Dionisio. A copy of this report, LIC 809-D's, and Appeal Rights were provided.

Ulysses Coronel
Jose Anguiano
DATE: 08/26/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/26/2026
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 08/26/2026 04:28 PM - It Cannot Be Edited


Created By: Jose Anguiano On 08/26/2026 at 02:39 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
, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245

FACILITY NAME: HAPPY LIFE ELDER CARE
FACILITY NUMBER: 198320424

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/26/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
09/02/2026
Section Cited
CCR
87309(a)

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Storage Space and Access (a)...licensee shall ensure that disinfectants, cleaning solutions, poisonous substances, knives...sharp objects...which could pose a danger to residents are in locked storage and are not left unattended if outside the locked storage.
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LIcensee agreed to keep cabinets innacessible to residents in care, and send proof to LPA Jose.Anguiano@dss.ca.gov.
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This requirement is not met as evidenced by: Based on observation, the licensee failed to ensure that chemicals were maintained in locked storage and inaccessible to residents in care. During the facility inspection, LPA observed cleaning chemicals/disinfectants stored inside an unlocked drawer that were accessible to residents. This violation poses an immediate health and safety risk to residents in care.
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Type B
09/02/2026
Section Cited
CCR87303(a)

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87303 Maintenance and Operation (a) The facility shall be clean, safe, sanitary and in good repair at all times.
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Licensee/Administrator agreed to remove the clutter and unsafe items, properly clean and organize the affected areas, and ensure the facility is maintained clean, safe, and sanitary. Proof of correction will be submitted to LPA Anguiano by the POC due date: Jose.Anguiano@dss.ca.gov
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This requirement is not met as evidenced by: Based on observation, the licensee failed to maintain the facility in a clean, safe, and sanitary condition. LPA observed cockroaches in kitchen drawers, excessive clutter and boxes in the garage, and a metal bed frame, electrical bed equipment, and trash in the backyard. This poses a potential health and safety 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.
Ulysses Coronel
NAME OF LICENSING PROGRAM MANAGER:
Jose Anguiano
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 08/26/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/26/2026


LIC809 (FAS) - (06/04)
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Document Has Been Signed on 08/26/2026 04:28 PM - It Cannot Be Edited


Created By: Jose Anguiano On 08/26/2026 at 02:55 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
, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245

FACILITY NAME: HAPPY LIFE ELDER CARE
FACILITY NUMBER: 198320424

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/26/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
09/02/2026
Section Cited
CCR
87411(a)

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87411 Personnel Requirements - General (a) Facility personnel shall at all times be sufficient in numbers, and competent to provide the services necessary to meet resident needs.
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Licensee/Administrator agreed to develop and submit a written staffing plan describing how the facility will ensure sufficient staff are available at all times to meet the care and supervision needs of all residents. The plan shall be submitted to LPA Anguiano at Jose.Anguiano@dss.ca.gov by the POC due date.
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This requirement is not met as evidenced by: Based on observation, the licensee failed to ensure sufficient staffing to meet residents’ care and supervision needs. Upon arrival, LPA observed only one staff member supervising six elderly residents, several of whom appeared to require assistance with ADLs, transfers, and incontinence care. This violation poses an immediate health and safety 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.
Ulysses Coronel
NAME OF LICENSING PROGRAM MANAGER:
Jose Anguiano
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 08/26/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/26/2026


LIC809 (FAS) - (06/04)
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