<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 191592571
Report Date: 01/12/2024
Date Signed: 01/17/2024 09:40:03 AM


Document Has Been Signed on 01/17/2024 09:40 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
CCLD Regional Office, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754



FACILITY NAME:PMC II GUEST HOMEFACILITY NUMBER:
191592571
ADMINISTRATOR:QUITORIANO, PRESCILAFACILITY TYPE:
740
ADDRESS:12802 CURTIS & KING ROADYTELEPHONE:
(562) 868-1435
CITY:NORWALKSTATE: CAZIP CODE:
90650
CAPACITY:6CENSUS: 3DATE:
01/12/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:30 AM
MET WITH:Ofelia Tanglao TIME COMPLETED:
02:00 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
Licensing Program Analyst Nicol Wesley conducted an unannounced Required 1 year inspection at the facility and met with staff Ofelia Tanglao and explained the purpose for todays visit. Elizabeth Almeron also was present. The facility phone number is 562 868 1435.

During the visit the Infection control domain was used and the following areas were observed/inspected: The facility had all postings at the front entrance, bathrooms, and throughout the facility. A Pre screening area with PPE supplies was observed upon entry into the facility.

A tour of the entire physical plant was completed, that included: Living room, Laundry area, 2 Kitchens(1 for staff), 2 Dining rooms(1 for staff), 5 Bedrooms, 2 staff rooms, 3 Bathrooms(1 located in residents bedroom), Family room, Washer and dryer area, Garage, and back yard area with covered patio for shade. Food supply was observed, medications, and medication logs were reviewed. The smoke detectors/carbon monoxide detector are operable. LPA observed two fire extinguisher in the kitchens. The water temperature was tested and measured 119.2 degrees F. The Administrator certificate for Emma Maralli Tamayo 6068127740 expires 12/20/25.

There were no deficiencies cited.

A copy of this report was given during the exit interview.
SUPERVISOR'S NAME: Lisa HicksTELEPHONE: (323) 981-3972
LICENSING EVALUATOR NAME: Nicol WesleyTELEPHONE: (323) 981-3975
LICENSING EVALUATOR SIGNATURE:
DATE: 01/12/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/12/2024
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 1