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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197800743
Report Date: 12/22/2023
Date Signed: 12/22/2023 03:46:36 PM

Document Has Been Signed on 12/22/2023 03:46 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
GREATER LA AC/SC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754
FACILITY NAME:CASITAS TRANQUILASFACILITY NUMBER:
197800743
ADMINISTRATOR:LISA MAHERFACILITY TYPE:
772
ADDRESS:11921,23,25,27,29 ELLIOTT AVE.TELEPHONE:
(626) 350-5304
CITY:EL MONTESTATE: CAZIP CODE:
91732
CAPACITY: 15CENSUS: 12DATE:
12/22/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:14 PM
MET WITH:Lisa Maher, Program Director/AdministratorTIME COMPLETED:
04:00 PM
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Licensing Program Analyst (LPA) Cynthia Chan conducted the required annual inspection. LPA arrived unannounced and met with Administrator, Lisa Maher. The reason for the visit was explained. The facility is licensed as a social rehabilitation facility to serve ambulatory adults ages 18 through 59. There are currently 12 clients residing at the facility.

LPA utilized the Compliance and Regulatory Enforcement (CARE) tools to inspect the facility.
The facility consists of individual houses: House #1 has 2 client bedrooms, 1 bathroom, and a living room. The medication room is located adjacent to house #1. House #2 has 3 single client rooms, 1 bathroom, and a living room. House #10 has 2 client bedrooms, 1 bathroom, living room, and kitchen. House #12 has 2 client bedrooms, 1 bath, and living room. There are sufficient food supplies for 2 day perishable and a week of nonperishable items. Cleaning supplies and knives are locked. The facility is adhering to operational requirements. Staff are providing care and supervision to meet the needs of the clients.
Staff are continuing to clean and disinfect each day. There is sufficient staffing at the facility. There are no clients who rely on staff to perform all activities of daily living. The Social Rehabilitation facility has an administrator. Staff and Client files are maintained at the facility. LPA reviewed (4) personnel files and all have the required documentation. Staff receive on-going training throughout the year and have current first aid training. LPA reviewed 4 client files and they have the required documents such as the admission agreement, medical assessment with the TB test result, consent forms, and needs/appraisal services plan. The facility provides devices with internet access for clients to use. The medications are centrally stored and locked. The facility uses the Medication Administration Record (MAR) log to document medications given. LPA reviewed medications for 4 clients and staff are administering them as prescribed. There are no clients with prohibited or restricted health conditions. The Emergency Disaster Plan is current and has the appropriate emergency procedures listed. Facility is conducting monthly disaster drills.

There are no deficiencies observed today. Exit interview held and a copy of this report was given to L.Maher.
SUPERVISORS NAME: Tony Vasallo
LICENSING EVALUATOR NAME: Cynthia D Chan
LICENSING EVALUATOR SIGNATURE: DATE: 12/22/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/22/2023
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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