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

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197600960
Report Date: 02/09/2022
Date Signed: 02/09/2022 11:58:44 AM

Document Has Been Signed on 02/09/2022 11:58 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:AIZABEL HOMEFACILITY NUMBER:
197600960
ADMINISTRATOR:TOLENTINO, MARIA LILIANFACILITY TYPE:
735
ADDRESS:1425 ETHEL ST.TELEPHONE:
(818) 545-3975
CITY:GLENDALESTATE: CAZIP CODE:
91207
CAPACITY: 6CENSUS: 5DATE:
02/09/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:26 AM
MET WITH:Maura Panganiban, AdministratorTIME COMPLETED:
12:07 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 (LPA) Alberto Lopez conducted an unannounced Required- 1-year visit focusing on COVID-19 Infection Control Practices. LPA met with Administrator Maura Panganiban and explained the purpose of the visit. Administrator certificate expires 08/19/2023 Last fire drill was on 11/30/2021. Client’s are from Lanterman Regional Center. Home is level 4G.

Structure:
The Facility has three shared rooms, 1 full and 2 half bathrooms, laundry room, kitchen, living room, dining room and den. Back yard has seating and shade to accommodate clients. Passageways were clear of obstructions.

The following were observed/inspected:

· COVID-19 signs are posted at the entrance. Visitors are screened in the main entrance and a log is kept.
· LPA was screened for this visit.
· Infection control signs and other COVID-19 signs are posted throughout the facility in the bathrooms, kitchen, and hallway to promote handwashing, cough/sneeze etiquette, and physical distancing.
· Facility has one designated isolation room.
· 3 client rooms, common areas, bathrooms, and outdoor physical plant was inspected.
· No client rooms are equipped with alcohol-based hand sanitize but available at facility
· Five (5) centrally stored client medication records were reviewed.
· Staff responsible for direct care and supervision were observed wearing masks.
· Clients were not observed wearing masks but adhering to public health social distance guidelines.
· Sufficient supply of perishable food for 2 days & non-perishable food for 7 days were observed.
· A posted Emergency Disaster Plan was observed posted at facility.
· PPE's were observed.
· Staff and resident files were not reviewed during today's visit.
Exit interview was conducted with Assistant Administrator Maura Panganiban. A copy of the report was provided.
SUPERVISORS NAME: Christine Yee
LICENSING EVALUATOR NAME: Alberto Lopez
LICENSING EVALUATOR SIGNATURE: DATE: 02/09/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/09/2022
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