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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 191592149
Report Date: 02/11/2025
Date Signed: 02/11/2025 10:51:02 AM

Document Has Been Signed on 02/11/2025 10:51 AM - 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:LOVING CARE GUEST HOMEFACILITY NUMBER:
191592149
ADMINISTRATOR/
DIRECTOR:		SABIO, MARILYNFACILITY TYPE:
735
ADDRESS:15027 - 15031 BLACKWOOD STTELEPHONE:
(626) 917-2312
CITY:LA PUENTESTATE: CAZIP CODE:
91744
CAPACITY: 12CENSUS: 11DATE:
02/11/2025
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:48 AM
MET WITH:June Sabio-caregiverTIME VISIT/
INSPECTION COMPLETED:
10:40 AM
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Program Analyst (LPA) Vaid made an unannounced visit to the facility to conduct a Case Management visit to evaluate client displaced from the Eaton Fires in Altadena. Health and Safety inspection. LPA met with caregiver- June Sabio and explained the purpose for the visit. The facility is licensed to care for up to (12) Adults, ages 18 through 59, ambulatory only. Fire clearance approves Six (6) clients in 15027 building and six (6) clients in house 15031. Marilyn Sabio-Administrator arrived soon after to assist with the tour.

The facility contains 2 Houses, House #1 is a structure located in the back (15027) consists of (4) client bedrooms, (2) full bathrooms, kitchen area which is also utilized as a staff room, living room and a backyard. House #2 located in front (15031) consists of (3) client bedrooms, (1) staff room, 2 full bathrooms, living room, dining area, kitchen, laundry area, office area front porch, patio and detached garage for storage.
Currently, there are eleven (11) clients living in the facility. The new client is from El Molino Guest Home, 2544 El Molino Ave, Altadena CA. The interior and exterior physical plant was inspected. Client bedrooms were toured. Each bedroom has a smoke detector and required furniture, linen, and sufficient closet space. Bathrooms contained hygiene supplies liquid soap, paper towels. LPA observed all windows to be in good repair. Exit doors are free of obstruction. Backyard was inspected and observed. Detached garage was toured. The garage was locked and inaccessible to clients in care. Kitchen knives, sharps objects, cleaning supplies and toxic substances are locked and inaccessible to clients.

LPA reviewed six (6) Client files. Client files and medications are centrally stored in the facility. Physician's Report (including TB and Ambulatory Status), Consent for Medical Treatment, Individual Program Plan (IPP), Behavioral Reports, Client Cash Resources, Special Incident Reports, Client Personal Property and Clients Personal Rights.

Continued on 809C......
SUPERVISORS NAME: Fernando Fierros
LICENSING EVALUATOR NAME: Sanjay Vaid
LICENSING EVALUATOR SIGNATURE: DATE: 02/11/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/11/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 2
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: LOVING CARE GUEST HOME
FACILITY NUMBER: 191592149
VISIT DATE: 02/11/2025
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The facility uses the Medication Administration Record (MAR) log to document medications given. Medications are administered as prescribed by the Physician.

There are sufficient food supplies of 2-day perishable and 7-day non-perishable items. The food is properly stored in the refrigerator. There are no clients with special diets residing at this facility. Pesticides and cleaning supplies are kept away from the food preparation areas. Kitchen is kept clean and free of pests. Plates, cups and utensils are kept cleaned and stored properly.

During tour of the physical plant with June Sabio, LPA did not observe any concerns regarding Health and Safety. Staff were observed to be assisting and engaging with the residents. Ten (10) clients have gone to day program, and did not interview them. Client#11 was interviewed.

Exit interview held and a copy of the report was provided to Marilyn Sabio.
SUPERVISORS NAME: Fernando Fierros
LICENSING EVALUATOR NAME: Sanjay Vaid
LICENSING EVALUATOR SIGNATURE:

DATE: 02/11/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/11/2025
LIC809 (FAS) - (06/04)
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