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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197800743
Report Date: 10/26/2024
Date Signed: 10/30/2024 11:21:32 AM

Document Has Been Signed on 10/30/2024 11:21 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK ASC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754
FACILITY NAME:CASITAS TRANQUILASFACILITY NUMBER:
197800743
ADMINISTRATOR/
DIRECTOR:		LISA MAHERFACILITY TYPE:
772
ADDRESS:11921,23,25,27,29 ELLIOTT AVE.TELEPHONE:
(626) 350-5304
CITY:EL MONTESTATE: CAZIP CODE:
91732
CAPACITY: 15CENSUS: 11DATE:
10/26/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:22 AM
MET WITH:Isela RecillasTIME VISIT/
INSPECTION COMPLETED:
11:40 AM
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Licensing Program Analyst (LPA) Christian Gutierrez conducted the required annual inspection. LPA arrived unannounced and met with mental health workers Isela Recillas and Carmen Roman. Program Director Lisa Maher was notified by phone 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 11 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.

LPA toured the facility and observed the following: Each client bedroom has the required furniture and bedding. There is extra clean linen and towels in a hallway closet. Smoke detectors/carbon monoxide devises were observed in each room and throughout the facility and are properly operating. The facility has one (1) fully charged fire extinguishers in each home. Cleaning supplies and toxic substances were observed to be inaccessible clients. Freezers are maintained at a temperature of 0-degree F and the refrigerators at a maximum of 40 degrees F. Sufficient supply of 2 days perishable & 7 days non-perishable foods was observed in the kitchen. Sharps are locked and placed in cabinet in kitchen. There are no firearms or weapons stored at the facility. The hot water temperature in the bathrooms were measured between the required range of 105-120 degrees F. The facility does not have a swimming pool or bodies of water on the premises There is a shaded seating area for the residents located in the front yard. Passageways and exits are free of obstruction. The garage is clean and has extra supplies.
SUPERVISORS NAME: Tony Vasallo
LICENSING EVALUATOR NAME: Christian Gutierrez
LICENSING EVALUATOR SIGNATURE: DATE: 10/26/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/26/2024
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
MONTEREY PARK ASC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754
FACILITY NAME: CASITAS TRANQUILAS
FACILITY NUMBER: 197800743
VISIT DATE: 10/26/2024
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Five (5) Staff files were reviewed and included Criminal clearance record, CPR/training, and health screening with TB. Five (5) Client files were reviewed and included physicians report, TB clearance. Earthquake drill was last conducted in October of 2024.Infectious control plan was reviewed. The medications are centrally stored and locked in a medication room. The facility uses the Medication Administration Record (MAR) log to document medications given. LPA reviewed medications for all clients, and they are being administered as prescribed by the physician.

No deficiencies were observed or cited during today's inspection exit interview conducted and a copy of the report was provided.




SUPERVISORS NAME: Tony Vasallo
LICENSING EVALUATOR NAME: Christian Gutierrez
LICENSING EVALUATOR SIGNATURE:

DATE: 10/26/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/26/2024
LIC809 (FAS) - (06/04)
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