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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197606347
Report Date: 01/16/2025
Date Signed: 01/16/2025 04:23:19 PM

Document Has Been Signed on 01/16/2025 04:23 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:COGSWELL GARDEN HOMEFACILITY NUMBER:
197606347
ADMINISTRATOR/
DIRECTOR:
LILIAN C. SALMORINFACILITY TYPE:
740
ADDRESS:5405 N. COGSWELL ROADTELEPHONE:
(626) 444-3523
CITY:EL MONTESTATE: CAZIP CODE:
91732
CAPACITY: 15CENSUS: 7DATE:
01/16/2025
TYPE OF VISIT:Case Management - Health ChecksUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
03:28 PM
MET WITH:Lilian Salmorin, AdministratorTIME VISIT/
INSPECTION COMPLETED:
04:25 PM
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Licensing Program Analyst (LPA) Noemi Galarza made unannounced case management visit regarding a self reported incident on the relocation of 2 residents from Bedell Family Crest, The # 197601322, 3267 Fair Oaks, Altadena, CA 91001 to Cogswell Garden Home due to mandatory evacuation orders from Fire Advisory. LPA met with Administrator Lilian Salmorin and explained the purpose of the visit. A physical plant tour of the facility was conducted to check the health and safety of the 2 evacuee residents.

The following observations were made:
  • Both relocated residents have designated rooms with beds, bedding/linen, and hygiene supplies. Residents are in need of more clothing. Residents do not use medical equipment and are ambulatory.
  • Medication Administration Records (MARs) for R1 only, medications, resident file documents were reviewed.
  • One (1) additional staff was hired to accommodate the increase in resident census.
  • Residents were transferred without medical insurance information and Face Sheet/Emergency Information. Regional Center has been notified.
  • Review of staff rosters indicate there is sufficient staffing available to provide care for residents of both facilities.
  • The facility has sufficient 2-day perishable and 7-day non perishable food supplies. The facility dining room is able to accommodate all residents.
  • The last routine fire inspection was conducted 12/19/2024. The last fire drill was conducted on 12/20/2024.
  • Administrator stated that it is unknown whether residents have responsible parties, and/or if they were notified.
Exit interview was conducted with Administrator Lilian Salmorin and a copy of the report was issued.
SUPERVISORS NAME: Lisa Hicks
LICENSING EVALUATOR NAME: Noemi Galarza
LICENSING EVALUATOR SIGNATURE: DATE: 01/16/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/16/2025
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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