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ICF/DD-N (Nursing)License activeMedi-Cal certified

LOS ANGELES WAY

ICF/DD-N (Nursing) · 6 licensed beds · Buena Park, CA

Homes of 4–15 beds for medically fragile people with developmental disabilities who need intermittent skilled nursing.

Address

LOS ANGELES WAY5940 LOS ANGELES WAYBuena Park, CA 90620 · Orange County

Phone: (714) 305-4773

Facility details

CDPH listing, data as of Oct 16, 2026
Facility type
ICF/DD-N (Nursing)
Licensed beds
6
Licensee
RSCR CALIFORNIA, INC. · Profit Corp
Administrator
GUTIERREZ, EDNA
CDPH facility ID
630018677
License number
550005583
First licensed
June 23, 2020
Current license
Jun 23, 2026 to Jun 22, 2027
CDPH district office
Orange

Federal certification (CMS)

CMS Provider of Services file
CMS Certification Number (CCN)
55G793
Status in CDPH's listing
Licensed And Certified
Program
Medi-Cal (Medicaid, Title XIX)
Participating since
December 10, 2020
Last certification survey
October 2, 2025
CMS certification status
Certified
In compliance (CMS)
Yes
Last certification action
Complaint
Ownership type (CMS)
Private (proprietary)
Certified beds (CMS)
6
Staffing reported to CMS
RN 0.5 · LVN/LPN 1.25 · direct care 5 · all employees 6.75

State citations and penalties (CDPH)

1 penalty, newest first

CDPH issues citations under Health and Safety Code §1424: Class AA (a violation that was a substantial factor in a resident's death), Class A (imminent danger or a substantial probability of death or serious harm) and Class B (a direct relationship to residents' health, safety or security). State citations explained

  • Class BOther

    Citation - B · Violations: 483.460(c) · Violation Oct 6, 2020 · Penalty #060016917 · Survey 4TWX11

    Status: Closed · Not appealed

Federal inspections (CMS-2567)

25 surveys since 2018 · CMS data through Oct 12, 2026

CDPH surveys certified ICFs for CMS. Each deficiency is a W-tag (a federal ICF/IID requirement), an E-tag (emergency preparedness) or a K-tag (Life Safety Code), cited at the standard level or, more seriously, the condition level. How to read an ICF inspection

Content note: these federal findings describe residents' care and can include abuse, neglect, injuries and medical details. They're shown as CMS published them; residents are identified only by number (such as "Client 1").

  1. · Complaint

    Event MPZV11 · 1 deficiency

    Official 2567 ↗
  2. · Complaint

    Event 0SVO11 · 3 deficiencies

    Official 2567 ↗
  3. · Complaint

    Event YSCY11 · 1 deficiency

    Official 2567 ↗
  4. · Complaint

    Event KEUU11 · no deficiencies cited

    Official 2567 ↗
  5. · Complaint

    Event 4WCG11 · 1 deficiency

    Official 2567 ↗
  6. · Recertification

    Event 33TW21 · 1 deficiency

    Official 2567 ↗
  7. · Complaint, Recertification

    Event 33TW11 · 8 deficiencies

    Official 2567 ↗
  8. · Complaint

    Event 54G811 · no deficiencies cited

    Official 2567 ↗
  9. · Complaint

    Event UED911 · 2 deficiencies

    Official 2567 ↗
  10. · Complaint

    Event CWVM11 · 1 deficiency

    Official 2567 ↗
  11. · Recertification

    Event ZSVW21 · 5 deficiencies

    Official 2567 ↗
  12. · Recertification

    Event ZSVW11 · 30 deficiencies (1 condition-level)

    Official 2567 ↗

From CMS's QCOR ICF/IID statement-of-deficiency download, saved Oct 26, 2026. CMS notes that ICF/IID data after March 19, 2026 may be incomplete while its systems migrate. Plans of correction and state-only (licensing) deficiencies aren't in that file; the official 2567 documents on CalHealthFind have them.

Complaints and reported incidents

CDPH doesn't publish complaints or facility-reported incidents as a bulk file, so they aren't on ICFLookup. Its CalHealthFind page for this facility lists them (intake date, allegation category and whether each was substantiated), along with state licensing deficiencies and ownership details.

Federal surveys that came from a complaint or an incident report do appear above, marked "Complaint" as the survey type.

Open this facility on CalHealthFind ↗How to file a complaint with CDPH

Change history

27 events, newest first

Dates marked "state record" are the agencies' own: the license date, federal survey dates and penalty issue dates. "Detected" changes are ones we noticed by comparing CDPH's monthly facility listing with the one before it, tracked since Oct 26, 2026.

  1. ReportFederal survey (complaint): 1 deficiency(state record)

    See this survey →
  2. ReportFederal survey (complaint): 3 deficiencies(state record)

    See this survey →
  3. ReportFederal survey (complaint): 1 deficiency(state record)

    See this survey →
  4. ReportFederal survey (complaint): no deficiencies(state record)

    See this survey →
  5. ReportFederal survey (complaint): 1 deficiency(state record)

    See this survey →
  6. ReportFederal survey (recertification): 1 deficiency(state record)

    See this survey →
  7. ReportFederal survey (complaint, recertification): 8 deficiencies(state record)

    See this survey →
  8. ReportFederal survey (complaint): no deficiencies(state record)

    See this survey →
  9. ReportFederal survey (complaint): 2 deficiencies(state record)

    See this survey →
  10. ReportFederal survey (complaint): 1 deficiency(state record)

    See this survey →

Sources: CDPH Licensed and Certified Healthcare Facility Listing (data as of Oct 16, 2026), CDPH State Enforcement Actions, and CMS's ICF/IID statement-of-deficiency (CMS-2567) and Provider of Services files. ICFLookup is not affiliated with CDPH or CMS; always confirm with CDPH's CalHealthFind ↗ before making a decision. See How our data works.