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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197608731
Report Date: 03/29/2023
Date Signed: 03/29/2023 05:57:10 PM


Document Has Been Signed on 03/29/2023 05:57 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
N LA & CEN COA AC/SC, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364



FACILITY NAME:GUINTO HOME CARE INC.FACILITY NUMBER:
197608731
ADMINISTRATOR:ALMA S. GUINTOFACILITY TYPE:
740
ADDRESS:38645 EASTON STREETTELEPHONE:
(661) 441-2814
CITY:PALMDALESTATE: CAZIP CODE:
93552
CAPACITY:5CENSUS: 4DATE:
03/29/2023
TYPE OF VISIT:Case Management - Health ChecksUNANNOUNCEDTIME BEGAN:
04:10 PM
MET WITH:Alma GuintoTIME COMPLETED:
06:05 PM
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On 03/29/2023 at 4:10 p.m. Licensing Program Analyst (LPA) Evelin Rios conducted an unannounced case management - health check visit for a new resident #1 (R1). The purpose of the visit is to determine the health and safety of R1 and gather information of R1s admission to this facility. LPA met with staff #1 (S1) and staff #2 (S2) whom granted access to the facility. S1 contacted Administrator Alma Guinto by telephone. LPA was able to speak to administrator. Alma stated she was on her way back to this facility from Westport Home - 197606597 with R1's belongings and medication.

At 4:18 p.m. LPA interviewed R1. R1 states although they did not know they were moving out today to this facility they do not want to return to Westport Home - 197606597. According to R1, they allowed staff to make arrangement on their behalf. R1 states they are satisfied with this facility. According to R1 they have not signed an admission agreement.

At 5:08 p.m. LPA interviewed Alma Guinto. According to Alma she received a call Teodora Cambiado requesting her to admit R1 after her day program moving up the day of relocation. Day Program dropped off R1 to this facility. Alma was not aware R1 did not know of the arrangement to move out today. Alma states she is completing the Admissions Agreement. At 5:32 p.m. LPA reviewed R1's records and medications.

Exit interview conducted. Copy of this report issued
SUPERVISOR'S NAME: Eva MillerTELEPHONE: (818) 596-4373
LICENSING EVALUATOR NAME: Evelin RiosTELEPHONE: 424-299-6104
LICENSING EVALUATOR SIGNATURE:
DATE: 03/29/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/29/2023
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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