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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197609014
Report Date: 11/10/2022
Date Signed: 11/10/2022 03:44:11 PM

Document Has Been Signed on 11/10/2022 03:44 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, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME:EL MOLINO MANORFACILITY NUMBER:
197609014
ADMINISTRATOR:PASCASIO, GLORIAFACILITY TYPE:
735
ADDRESS:2544 N EL MOLINO AVENUETELEPHONE:
(626) 639-4270
CITY:ALTADENASTATE: CAZIP CODE:
91001
CAPACITY: 36CENSUS: 29DATE:
11/10/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
02:30 PM
MET WITH:Zonel Pascasio, Assistant AdministratorTIME COMPLETED:
03:45 PM
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Licensing Program Analyst (LPA) Rosaura Valenzuela conducted an unannounced Required One (1) year Infection Control inspection to the facility. LPA met with Assistant Administrator Zonel Pascasio and explained the reason for the visit.

A tour of the physical plant was conducted at 2:35 pm and the following was noted:

There is only one entrance being utilized at the facility, there are required posters posted at the main door. Screening area is located immediately upon entrance. Sign in sheet, hand sanitizer, gloves, and masks are available. LPA was screened upon entry.

The facility had submitted and approved Mitigation Plan.

Signs to wear a mask and other COVID-19 prevention protocol signs were posted outside the door. Hand washing, coughing etiquette, physical distancing and other necessary signs were posted throughout the facility. The facility has a designated visitors' area in the backyard. The facility has sufficient stock of PPE in the storage room.

The facility has eighteen (18) bedrooms and eleven (11) bathrooms currently occupying twenty-nine (29) clients. Seventeen (17) rooms are shared rooms. One room is a private room.

(continued on LIC 809-C
SUPERVISORS NAME: Naira Margaryan
LICENSING EVALUATOR NAME: Rosaura Valenzuela
LICENSING EVALUATOR SIGNATURE: DATE: 11/10/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/10/2022
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME: EL MOLINO MANOR
FACILITY NUMBER: 197609014
VISIT DATE: 11/10/2022
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Living and dining room furniture were also checked. The living room is neat and clean. The facility maintains a comfortable temperature at 75 degrees. The smoke detectors are observed to be operational. There is a carbon monoxide detector in the facility. Fire extinguishers are located throughout the facility and were last serviced in October of 2022.

The side-yard of the facility has outdoor furniture with a covered shaded area for clients. There is no body of water at the facility. There are also several locked storage units in the facility that store cleaning products, tools, extra food, supplies, and the laundry machines.

Food Service/Kitchen area was sufficiently stocked with two (2) days of perishable and seven (7) days of non-perishable food. Knives and sharp objects were observed to be locked and inaccessible to residents.

The residents rooms are adequately furnished with appropriate furniture and lighting system.

The bathrooms were checked for cleanliness and proper operation. The hot water temperature was measured at 118.5 degrees F. There was enough clean linen available in stock in one of the cabinets.

Medications-LPA observed medications to be stored in two hallway side cabinets that were locked and inaccessible to clients. There is one (1) complete first aid kit.

No deficiencies cited at this time.

Exit interview conducted. A copy of this report was issued and signature obtained.
SUPERVISORS NAME: Naira Margaryan
LICENSING EVALUATOR NAME: Rosaura Valenzuela
LICENSING EVALUATOR SIGNATURE:

DATE: 11/10/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/10/2022
LIC809 (FAS) - (06/04)
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