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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197609014
Report Date: 11/12/2024
Date Signed: 11/12/2024 03:20:05 PM

Document Has Been Signed on 11/12/2024 03:20 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
WOODLAND HILLS S.RO, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME:EL MOLINO MANORFACILITY NUMBER:
197609014
ADMINISTRATOR/
DIRECTOR:		PASCASIO, GLORIAFACILITY TYPE:
735
ADDRESS:2544 N EL MOLINO AVENUETELEPHONE:
(626) 639-4270
CITY:ALTADENASTATE: CAZIP CODE:
91001
CAPACITY: 36CENSUS: 35DATE:
11/12/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:45 AM
MET WITH:Administrator, Zonel Pascasio and Direct Support Professional, Zosimo V. PascasioTIME VISIT/
INSPECTION COMPLETED:
03:30 PM
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Licensing Program Analyst (LPA) Antonia Alvizar-Ettima conducted a Required One (1) year annual visit and inspection. LPA met with Direct Support Professional (DSP) who granted entry and explained the reason for the visit. The Administrator was contacted via phone and arrived at 10:15AM and joined us.

The facility retains thirty-five (35) clients and is fire cleared for 36 ambulatory. Facility has 18 shared bedrooms. Disaster drill was last conducted on 06/20/2024. Required posting observed in facility (complaint hot line poster, personal rights, etc). Entry/exits are free of obstruction. The smoke detectors were checked and are hard wired throughout the facility. There is a carbon monoxide detector in the kitchen area. There is no body of water in the facility.

At 10:20AM Administrator and LPA conducted physical plant tour inside and outside. LPA utilized the Compliance and Regulatory Enforcement (CARE) tools for the visit today and observed the following:

Kitchen: The kitchen appeared clean, the appliances and fixtures functional. Knives are locked in drawer. The kitchen is kept locked at all times. LPA observed at least two (02) days perishable and seven (07) days non-perishable food at the facility that is properly stored. Frozen foods are wrap, dated, and stored properly as well. Food storage and preparation areas are clean and inaccessible to pests. LPA observed cleaning supplies, and emergency foods supplies locked up in a storage room next to laundry room. There were three (03) freezers fully stocked with meats and a refrigerator that had additional juices and milk. The bread is purchased weekly for freshness.

The Bedrooms: There are eighteen (18) bedrooms in the facility. LPA checked random rooms and observed them to be well kept. Bedrooms were clean, properly furnished, had appropriate bedding and linens. There is sufficient lighting and closet space.
SUPERVISORS NAME: Naira Margaryan
LICENSING EVALUATOR NAME: Antonia Alvizar-Ettima
LICENSING EVALUATOR SIGNATURE: DATE: 11/12/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/12/2024
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
WOODLAND HILLS S.RO, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME: EL MOLINO MANOR
FACILITY NUMBER: 197609014
VISIT DATE: 11/12/2024
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The Bathrooms: Each bedroom has a shared bathroom. Bathrooms were observed to be clean, sanitary and with necessary supplies. Hot water temperature measured at a range of 108.5°F to 116.6°F and within the required range. Client’s personal hygiene supplied are kept in their personal space. Cleaning supplies are being stored in a locked cabinet next to laundry room. Towels and washcloths are not shared. There was enough clean linen available in the cabinets stores in the hallway.

Common Areas: The Living room, family room and dining room areas appeared clean and were properly furnished. Furniture in common area were observed to be in good repair. Office is located next to the family room by the entrance of the facility. No obstructions and/or tripping hazards were observed throughout the facility.

Temperature of facility wall thermostat was set at 72.0°F and observed to be within the required range. Fire extinguisher were observed to be located in the hallway and laundry room. Fire extinguisher were observed to be operable with service tag dated 10/24/24. The smoke detectors were checked and are hard wired throughout the facility. There was a carbon monoxide detector in the living room.


Surrounding Grounds: There is a covered patio area which had patio table with chairs for clients use. The furniture in surrounding grounds area were observed to be in good repair.

Medication were observed to be locked, inaccessible and stored in the cabinet in the dining area. There was a complete First Aid kit and extra hygiene supplies located inside the medication cabinet.



Client records. LPA reviewed four (04) client records. Client records are complete and current at this time. Staff records were also reviewed. Staff records were reviewed, they all have criminal record clearances and associated to this facility. Staff have current first aid and training documentation showing training completed. Administrator's certificate was observed to be current.

Pursuant to Title 22 Division 6 of the CA Code of Regulations, no deficiencies observed during the visit. Exit interview conducted and a copy of the report issued.
SUPERVISORS NAME: Naira Margaryan
LICENSING EVALUATOR NAME: Antonia Alvizar-Ettima
LICENSING EVALUATOR SIGNATURE:

DATE: 11/12/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/12/2024
LIC809 (FAS) - (06/04)
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