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

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197602450
Report Date: 08/08/2023
Date Signed: 08/08/2023 12:01:18 PM

Document Has Been Signed on 08/08/2023 12:01 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
GREATER LA AC/SC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754
FACILITY NAME:VILLA ESPERANZA - ALLEN HOUSEFACILITY NUMBER:
197602450
ADMINISTRATOR:MARITES BELTRANFACILITY TYPE:
735
ADDRESS:1808 LAS LUNASTELEPHONE:
(626) 405-1722
CITY:PASADENASTATE: CAZIP CODE:
91107
CAPACITY: 6CENSUS: 5DATE:
08/08/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
08:39 AM
MET WITH:Steven Castellanos - Residential CounselorTIME COMPLETED:
12:15 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) Mary Flores conducted an unannounced annual using the CARE tool. LPA met with Steven Castellanos residential counselor and explained the reason for the visit. Administrator Marites Gacayan arrived 10 minutes later.

Facility is a single story home and it is licensed to served 6 ambulatory clients between the ages of 18 to 59 years old. Facility has no fences or large bodies of water. Facility has 3 client rooms, 1 staff room, 2 client bathrooms, a living room, a dinning room, a kitchen, an activity area, a basement inaccessible to clients, a shaded sitting in the front porch and a back yard.

LPA conducted a tour with Seven Castellanos and observed the following:
Facility is in good repair indoor and outdoor. Living room and dining room provide sufficient sitting space. Kitchen was observed clean and sufficient food was observed for at least 2 days worth of perishables and 7 days of non-perishables. Cleaning supplies and sharps were observed locked. Each client bedroom (3) has the required furniture and bedding, and sufficient lighting. Bathrooms (2) were observed clean and in working condition, water temperature was tested between 115.8 - 118.5 which is within the required 105-120 degrees F. Backyard is clean and front porch provides a sitting area. Smoke/Carbon monoxide were tested and fire extinguishers were observed.
LPA reviewed medication and P&I money for 5 clients and 5 staff files. LPA reviewed surety bond, Infection Control plan, and disaster plan. Administrator certificate was observed # 6033708735 exp. date: 9/4/23.

LPA conducted interviews with 2 staff and 1 client.

No Deficiencies were noted during this visit.
Exit interview was conducted with Marites Beltran and a copy of this report was provided.
SUPERVISORS NAME: Tony Vasallo
LICENSING EVALUATOR NAME: Mary G Flores
LICENSING EVALUATOR SIGNATURE: DATE: 08/08/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/08/2023
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