Admission, assessment, and eviction
Cited in 2 reports, with 4 deficiencies in total.
SUPERCARE GUEST HOME
13449 BIOLA AVE, La Mirada CA 90638
6 bedsLatest official report Dec 9, 2025Licensed
Additional info
- Telephone
- (714) 244-5885
- Licensee
- HOLY HOME 2020 INC.
- Administrator
- JABONERO, JANICE RACHELLE
- Contact
- JABONERO, JANICE RACHELLE
- License first date
- Dec 2, 2020
- License effective date
- Dec 2, 2020
- District office
- MONTEREY PARK ASC · (323) 980-4934
- Regional office
- 28
- Clients served
- 935 - ELDERLY
Summary
The available records show 4 Type A and 13 Type B deficiencies for this facility.
- Most recent inspection
- Dec 9, 2025
- Most recent deficiency
- Nov 19, 2024
1 later report, on Dec 9, 2025, recorded no deficiencies, though the records do not say whether they were follow-ups.
What Type A and Type B mean
- Type A
- 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
- Violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care.
Both classifications are published by California CDSS and are shown as published. SeniorLivingFacts does not rename them or add a severity level of its own.
At a glance
Counts cover the five-year public record. Typical figures are the median for the 1,564 Los Angeles County facilities licensed for 6 or fewer beds.
In the available public five-year record, CCLD published 9 reports for this facility: 7 inspections, 2 complaint investigations, and 0 licensing or administrative records.
Those records contain 4 Type A and 13 Type B deficiencies.
1 deficiencies have explicit official correction or clearance evidence in the loaded records.
- Official inspections
- 7
- Recorded deficiencies
- 17
- Type A deficiencies
- 4
- Type B deficiencies
- 13
- Substantiated complaints
- 0
- Repeated topics
- 2
More than the typical 4
1 in the last 12 months
Well above the typical 1
0 in the last 12 months
Most this size have none
0 in the last 12 months
Most this size have none
0 in the last 12 months
Most this size also have none
0 in the last 12 months
Last 36 months
Repeated topics
Topics cited in more than one report during the last 36 months. A repeat may show a pattern worth asking about. Each date opens its report below.
Food service
Cited in 2 reports, with 2 deficiencies in total.
Official report history
All preserved reports from the most recent to the oldest, sortable by report type.
Inspection
No deficiencies recorded in this report
Inspection
Health conditions and treatmentsType B
- Official classification
- Type B
- Official code
- 87633(a)(1)
- Regulation authority
- CCR
What the official deficiency says
(a) The licensee shall be permitted to accept or retain residents who have been diagnosed as terminally ill by his or her physician and surgeon and who may or may not have restrictive and/or prohibited health conditions, to reside in the facility and receive hospice services from a hospice agency in the facility, when all of the following conditions are met: (1) The licensee has received a hospice care waiver from the department. This requirement is not met as evidenced by: Deficient Practice Statement Based on record review, the licensee did not comply with the section cited above in 1 out of 6 residents, because the facility has an approved hospice waiver for 4 residents however there are 5 on hospice which poses a potential health, safety or personal rights risk to persons in care.
Official plan of correction
POC Due Date: 11/26/2024 Plan of Correction **POC Cleared During Visit because administrator has emailed LPA the hospice waiver increase request** Administrator is to ensure that an approved hospice waiver to cover all residents is on file at all times. Administrator is to submit to LPA a hospice waiver increase request to LPA by the POC due date.
Official record says corrected or clearedRecorded in report dated Nov 19, 2024
Plan of correction recorded
Inspection
Admission, assessment, and evictionType B
- Official classification
- Type B
- Official code
- 87463(c)
- Regulation authority
- CCR
What the official deficiency says
(c) The licensee shall arrange a meeting with the resident, the resident's representative, if any, appropriate facility staff, and a representative of the resident's home health agency, if any, when there is a significant change in the resident's condition, or once every 12 months, whichever occurs first, as specified in Section 87467, Resident Participation in Decision. This requirement is not met as evidenced by: Deficient Practice Statement Based on record review, the licensee did not comply with the section cited above in 1 out of 6 residents, as one resident's appraisal had not been completed within the past 12 months, which poses a potential health, safety or personal rights risk to persons in care.
Official plan of correction
POC Due Date: 11/29/2024 Plan of Correction Licensee/Administrator is to ensure that residents have a reappraisal conducted at least once every 12 months at all times. Licensee/Administrator is to conduct a reappraisal for the identified resident and send proof to LPA that it has been conducted by the POC due date.
Plan of correction recorded
Correction not verified in available records
Food serviceType A
- Official classification
- Type A
- Official code
- 87555(b)(26)
- Regulation authority
- CCR
What the official deficiency says
(b) The following food service requirements shall apply: (26) Supplies of nonperishable foods for a minimum of one week and perishable foods for a minimum of two days shall be maintained on the premesis. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation, the licensee did not comply with the section cited above in six out of six resident, because the facility did not meet the sufficient 2-day perishable and 7-day nonperishable food supply for 6 residents, which poses an immediate health, safety or personal rights risk to persons in care.
Official plan of correction
POC Due Date: 11/16/2024 Plan of Correction Licensee/Administrator is to ensure that the facility has the required ammount of food in the facility at all times. Licensee/Administrator is to purchase the required supply of perishable and non-perishable foods and email the receipt of the purchase to the LPA by the POC due date.
Plan of correction recorded
Correction not verified in available records
Complaint
Allegations0 substantiated · 4 unsubstantiated · 0 unfounded
No deficiencies recorded in this reportInspection
Dementia careType A
- Official classification
- Type A
- Official code
- 87705(f)(1)
- Regulation authority
- CCR
What the official deficiency says
(f) The following shall be stored inaccessible to residents with dementia: (1) Knives, matches, firearms, tools and other items that could constitute a danger to the resident(s). This requirement is not met as evidenced by: Deficient Practice Statement Based on observation, knife was observed a top kitchen countertop, the licensee did not comply with the section cited above in 6 out of 6 residents which poses an immediate health, safety or personal rights risk to persons in care.
Official plan of correction
POC Due Date: 12/10/2023 Plan of Correction Staff secured knife during visit. Licensee will retrain staff on above regulation and send proof of staff receiving training by 12/16/23.
Corrective action observedRecorded in report dated Dec 9, 2023
Plan of correction recorded
Dementia careType A
- Official classification
- Type A
- Official code
- 87705(f)(2)
- Regulation authority
- CCR
What the official deficiency says
(f) The following shall be stored inaccessible to residents with dementia: (2) Over-the-counter medication, nutritional supplements or vitamins, alcohol, cigarettes, and toxic substances such as certain plants, gardening supplies, cleaning supplies and disinfectants. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation, cleaning solutions and disinfectants were accessible in kitchen and bathroom#1, the licensee did not comply with the section cited above in 6 out of 6 residents which poses an immediate health, safety or personal rights risk to persons in care.
Official plan of correction
POC Due Date: 12/10/2023 Plan of Correction Staff secured both cabinets during visit. Licensee will retrain staff on above regulation and send proof of staff receiving training by 12/16/23.
Corrective action observedRecorded in report dated Dec 9, 2023
Plan of correction recorded
Staffing, personnel, and trainingType B
- Official classification
- Type B
- Official code
- 87412(a)(11)
- Regulation authority
- CCR
What the official deficiency says
(a) The licensee shall ensure that personnel records are maintained on the licensee, administrator and each employee. Each personnel record shall contain the following information: (11) A health screening as specified in Section 87411, Personnel Requirements - General. This requirement is not met as evidenced by: Deficient Practice Statement Based on record review, S1 and S2 were missing health screeening, the licensee did not comply with the section cited above in 6 out of 6 residents which poses/posed a potential health, safety or personal rights risk to persons in care.
Official plan of correction
POC Due Date: 12/16/2023 Plan of Correction Licensee will submit health screening by 12/16/23 and maintain in personnel records.
Plan of correction recorded
Correction not verified in available records
Staffing, personnel, and trainingType B
- Official classification
- Type B
- Official code
- 87412(a)(13)(B)
- Regulation authority
- CCR
What the official deficiency says
(a) The licensee shall ensure that personnel records are maintained on the licensee, administrator and each employee. Each personnel record shall contain the following information: (13) For employees that are required to be fingerprinted pursuant to Section 87355, Criminal Record Clearance: (B) Documentation of either a criminal record clearance or a criminal record exemption as required by Section 87355(e). This requirement is not met as evidenced by: Deficient Practice Statement Based on record review, S3 did not have proof of documented criminal record clearance or criminal record exepmtion,the licensee did not comply with the section cited above in 6 out of 6 residents, which poses/posed a potential health, safety or personal rights risk to persons in care.
Official plan of correction
POC Due Date: 12/16/2023 Plan of Correction Licensee will submit proof of clearance or exepmtion via email by 12/16/23.
Plan of correction recorded
Correction not verified in available records
Staffing, personnel, and trainingType B
- Official classification
- Type B
- Official code
- 1569.625(b)(1)
- Regulation authority
- HSC
What the official deficiency says
(1) The department shall adopt regulations to require staff members of residential care facilities for the elderly who assist residents with personal activities of daily living to receive appropriate training. This training shall consist of 40 hours of training. A staff member shall complete 20 hours, including six hours specific to dementia care, as required by subdivision (a) of Section 1569.626 and four hours specific to postural supports, restricted health conditions, and hospice care, as required by subdivision (a) of Section 1569.696, before working independently with residents. The remaining 20 hours shall include six hours specific to dementia care and shall be completed within the first four weeks of employment. The training coursework may utilize various methods of instruction, including, but not limited to, lectures, instructional videos, and interactive online courses. The additional 16 hours shall be hands-on training. This requirement is not met as evidenced by: Deficient Practice Statement Based on record review, S1, S3,S4,S5 did not have documented initial dementia training within 4 weeks of employment, the licensee did not comply with the section cited above in 6 out of 6 residents which poses/posed a potential health, safety or personal rights risk to persons in care.
Official plan of correction
POC Due Date: 12/16/2023 Plan of Correction Licensee will review above regulation and certify via email understaning of regulation.
Plan of correction recorded
Correction not verified in available records
Staffing, personnel, and trainingType B
- Official classification
- Type B
- Official code
- 1569.625(b)(2)
- Regulation authority
- HSC
What the official deficiency says
(2) In addition to paragraph (1), training requirements shall also include an additional 20 hours annually, eight hours of which shall be dementia care training, as required by subdivision (a) of Section 1569.626, and four hours of which shall be specific to postural supports, restricted health conditions, and hospice care, as required by subdivision (a) of Section 1569.696. This training shall be administered on the job, or in a classroom setting, or both, and may include online training. This requirement is not met as evidenced by: Deficient Practice Statement Based on record review, S1 and S3, did not have documented annual training, the licensee did not comply with the section cited above in 6 out of 6 residents which poses/posed a potential health, safety or personal rights risk to persons in care.
Official plan of correction
POC Due Date: 12/16/2023 Plan of Correction Licensee will conduct training on above regulation and send proof by 12/16/23.
Plan of correction recorded
Correction not verified in available records
Admission, assessment, and evictionType B
- Official classification
- Type B
- Official code
- 87458(a)
- Regulation authority
- CCR
What the official deficiency says
(a) Prior to a person's acceptance as a resident, the licensee shall obtain and keep on file, documentation of a medical assessment, signed by a physician, made within the last year. The licensee shall be permitted to use the form LIC 602 (Rev. 9/89), Physician's Report, to obtain the medical assessment. This requirement is not met as evidenced by: Deficient Practice Statement Based on record review, R6 did not have required annual medical assessment, the licensee did not comply with the section cited above in 1 out of 6 residents which poses/posed a potential health, safety or personal rights risk to persons in care.
Official plan of correction
POC Due Date: 12/16/2023 Plan of Correction Licensee will submit medical assessment by 12/16/23.
Plan of correction recorded
Correction not verified in available records
Admission, assessment, and evictionType B
- Official classification
- Type B
- Official code
- 87458(b)(1)
- Regulation authority
- CCR
What the official deficiency says
(b) The medical assessment shall include, but not be limited to: (1) A physical examination of the resident indicating the physician's primary diagnosis and secondary diagnosis, if any and results of an examination for communicable tuberculosis, other contagious/infectious or contagious diseases or other medical conditions which would preclude care of the person by the facility. This requirement is not met as evidenced by: Deficient Practice Statement Based on record review, R6 did not have medical assessment with TB results, the licensee did not comply with the section cited above in 1 out of 6 residents which poses/posed a potential health, safety or personal rights risk to persons in care.
Official plan of correction
POC Due Date: 12/16/2023 Plan of Correction Licensee will submit medical assessemnt with TB results by 12/16/23.
Plan of correction recorded
Correction not verified in available records
Admission, assessment, and evictionType B
- Official classification
- Type B
- Official code
- 87458(b)(5)
- Regulation authority
- CCR
What the official deficiency says
(b) The medical assessment shall include, but not be limited to: (5) The determination whether the person is ambulatory or nonambulatory as defined in Section 87101(a) or (n), or bedridden as defined in Section 87455(d). The assessment shall indicate whether nonambulatory status is based upon the resident's physical condition, mental condition or both. This requirement is not met as evidenced by: Deficient Practice Statement Based on record review, R6 did have medical assessment that indicated ambulatory status, the licensee did not comply with the section cited above in 1 out of 6 residents which poses/posed a potential health, safety or personal rights risk to persons in care.
Official plan of correction
POC Due Date: 12/16/2023 Plan of Correction Licensee will submit medical assessment that indicated ambulatory status.
Plan of correction recorded
Correction not verified in available records
Food serviceType B
- Official classification
- Type B
- Official code
- 87555(b)(27)
- Regulation authority
- CCR
What the official deficiency says
(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 is not met as evidenced by: Deficient Practice Statement Based on observation, several dead roaches were observed in lower kitchen cabinet near stove, the licensee did not comply with the section cited above in 6 out of 6 residents which poses/posed a potential health, safety or personal rights risk to persons in care.
Official plan of correction
POC Due Date: 12/16/2023 Plan of Correction Licensee will provide pest control contract and keep facility free from insects. Licensee will clean out cabinet with dead insects.
Plan of correction recorded
Correction not verified in available records
Dementia careType B
- Official classification
- Type B
- Official code
- 87705(c)(5)
- Regulation authority
- CCR
What the official deficiency says
(c) Licensees who accept and retain residents with dementia shall be responsible for ensuring the following: (5) Each resident with dementia shall have an annual medical assessment as specified in Section 87458, Medical Assessment, and a reappraisal done at least annually, both of which shall include a reassessment of the resident's dementia care needs. This requirement is not met as evidenced by: Deficient Practice Statement Based on record review, R2 is not have updated medical assessment, the licensee did not comply with the section cited above in 1 out of 6 residents which poses/posed a potential health, safety or personal rights risk to persons in care.
Official plan of correction
POC Due Date: 12/16/2023 Plan of Correction Licensee will submit new medical assessment and provide annually.
Plan of correction recorded
Correction not verified in available records
Complaint
Allegations0 substantiated · 1 unsubstantiated · 0 unfounded
No deficiencies recorded in this reportInspection
No deficiencies recorded in this report
Inspection
Dementia careType A
- Official classification
- Type A
- Official code
- 87705(c)(1)
- Regulation authority
- CCR
What the official deficiency says
(c) Licensees who accept and retain residents with dementia shall be responsible for ensuring the following: (1) The facility has a nonambulatory fire clearance for each room that will be used to accommodate a resident with dementia who is unable to or unlikely to respond either physically or mentally to oral instructions relating to fire or other dangers and to independently take appropriate actions during emergencies or drills. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation, interview, and record review, the licensee did not comply with the section cited above in (1) of (4) dementia care residents residing in a detached bedroom that does not have proper fire clearance for non-ambulatory, which poses an immediate health, safety or personal rights risk to persons in care.
Official plan of correction
POC Due Date: 03/08/2023 Plan of Correction Licensee will place resident in a proper non-ambulatory approved room. Pictures of the emptied room and pictures of the resident's new placement room will be provided to LPA via email by the POC due date.
Plan of correction recorded
Correction not verified in available records
Health conditions and treatmentsType B
- Official classification
- Type B
- Official code
- 87608(a)(3)
- Regulation authority
- CCR
What the official deficiency says
(a) Based on the individual's preadmission appraisal, and subsequent changes to that appraisal, the facility shall provide assistance and care for the resident in those activities of daily living which the resident is unable to do for himself/herself. Postural supports may be used under the following conditions: (3) A written order from a physician indicating the need for the postural support shall be maintained in the resident's record. The licensing agency shall be authorized to require other additional documentation if needed to verify the order. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation, interview, record review, the licensee did not comply with the section cited above in (2) residents with half bed rails that did not have a written order from a physician, which poses a potential health, safety or personal rights risk to persons in care.
Official plan of correction
POC Due Date: 03/24/2023 Plan of Correction Licensee will obtain the written order from each resident's physician, in question, to use the bed rails. A copy of the written order will be emailed to LPA by the POC due date.
Plan of correction recorded
Correction not verified in available records
Dementia careType B
- Official classification
- Type B
- Official code
- 87705(c)(5)
- Regulation authority
- CCR
What the official deficiency says
(c) Licensees who accept and retain residents with dementia shall be responsible for ensuring the following: (5) Each resident with dementia shall have an annual medical assessment as specified in Section 87458, Medical Assessment, and a reappraisal done at least annually, both of which shall include a reassessment of the resident's dementia care needs. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation, interview, record review, the licensee did not comply with the section cited above in (1) of (4) dementia care residents had a current medical assessment but did not have a current appraisal on file, which poses a potential health, safety or personal rights risk to persons in care.
Official plan of correction
POC Due Date: 03/10/2023 Plan of Correction Licensee completed a new appraisal for the resident in question during the visit and provided it to LPA for clearance of deficiency.
Plan of correction recorded
Correction not verified in available records
Inspection
No deficiencies recorded in this report
Source and limits
California Department of Social Services, Community Care Licensing Division. Public facility history is described by the source as a five-year window. Older records and previous-licensee history may require a regional-office request. Type 741 RCFE-CCRCs, nursing homes, and other care settings are excluded from this page.
Read the data methodology