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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197607034
Report Date: 06/08/2021
Date Signed: 06/18/2021 10:13:42 AM

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:CARDINAL YU-PIN MANORFACILITY NUMBER:
197607034
ADMINISTRATOR:KUN HUFACILITY TYPE:
740
ADDRESS:15602 BELSHIRE AVENUETELEPHONE:
(562) 926-1289
CITY:NORWALKSTATE: CAZIP CODE:
90650
CAPACITY:49CENSUS: 20DATE:
06/08/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:30 PM
MET WITH:Jerry Lo and Kun(Wendy) HuTIME COMPLETED:
03:30 PM
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Licensing Program Analysts (LPAs) Nicol Wesley and Luis Mora conducted a Required 1 year inspection at the facility and met with Licensee Kun(Wendy) Hu and Administrator Jerry Lo and explained the purpose for todays visit. The facility phone number is 562 926 1289.

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. Hand sanitizing gel and masks were located at the entry of each room. A Pre screening area with PPE supplies was observed upon entry into the facility. .

LPAs conducted a complete tour of the facility. Resident medications, and medication logs were reviewed. The smoke detectors/carbon monoxide detector are operable. LPAs observed 12 fire extinguishers throughout the facility. The licensee and administrator was requested to re submit the facility mitigation plan report by June 15, 2021, to avoid citations.

Administrators certificate for Kun(Wendy) Hu #6000702740 expires on 10/10/2021.

Due to technical difficulties LPAs terminated the visit and will return to continue on another day. There were no deficiencies cited during todays visit.

Exit interview conducted.
SUPERVISOR'S NAME: Rebecca OrendainTELEPHONE: (323) 981-3961
LICENSING EVALUATOR NAME: Nicol WesleyTELEPHONE: (323) 981-3975
LICENSING EVALUATOR SIGNATURE:

DATE: 06/08/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/08/2021
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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