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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 191500146
Report Date: 07/21/2022
Date Signed: 07/21/2022 03:18:04 PM


Document Has Been Signed on 07/21/2022 03:18 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, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754



FACILITY NAME:ARTESIA CHRISTIAN HOMEFACILITY NUMBER:
191500146
ADMINISTRATOR:MICHELLE ROBISONFACILITY TYPE:
741
ADDRESS:11614 EAST 183RD STREETTELEPHONE:
(562) 865-5218
CITY:ARTESIASTATE: CAZIP CODE:
90701
CAPACITY:143CENSUS: 88DATE:
07/21/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:59 AM
MET WITH:Michelle Robison; Executive DirectorTIME COMPLETED:
03:32 PM
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Licensing Program Analyst (LPA) David Sicairos conducted an unannounced annual visit using the Infection Control Evaluation Tool. LPA met with Executive Director Michelle Robison and explained the reason for the visit. Physical Plant was toured, medications were reviewed, and food supply was inspected.

LPA and Ms. Robison toured the facility including common areas and a random sample of resident rooms. There are multiple shaded seating areas for the residents throughout the facility. Passageways and exits are free of obstruction. The water temperature was tested in a random selection of resident bedrooms and measured between 108F - 117F which is within the required 105F - 120F degrees. Grab bars and non-skid mats were observed in resident bathrooms. Resident bedrooms have the required furniture such as bed frames, dressers, lamps and chairs. Bedrooms also have sufficient closet space. Resident beds have the required linen and the linen is in good condition. Smoke detectors and carbon monoxide detectors were observed throughout the facility and were tested and operable during the visit. There are multiple fire extinguishers located throughout the facility. Kitchen appliances are clean and were operating at the time of the visit. Sharps are locked and are inaccessible to residents. Cleaning supplies and disinfectants are locked and are inaccessible to the residents. First Aid kits were fully stocked with current manual.
  • Signs are posted throughout the facility to promote hand washing, cough/sneeze etiquette, and physical distancing.
  • Staff were observed wearing masks and screening visitors at entry.
  • Sufficient supply of 2 days perishable & 7 days non-perishable foods were observed.
  • 11 resident medications were reviewed at random. Medications are centrally stored in moving carts and in the medication rooms. Medications are given as prescribed.
  • Staff and Resident files were not reviewed during today's visit.

Per California Code of Regulations, Title 22, and California Health and Safety Code, there were no deficiencies observed during the visit. Exit interview held and a copy of the report was provided.
SUPERVISOR'S NAME: Stefanie CoronelTELEPHONE: (323) 981-3961
LICENSING EVALUATOR NAME: David SicairosTELEPHONE: (323) 981-3982
LICENSING EVALUATOR SIGNATURE:
DATE: 07/21/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/21/2022
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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