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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197800744
Report Date: 12/14/2023
Date Signed: 12/14/2023 04:34:27 PM

Document Has Been Signed on 12/14/2023 04:34 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 ESPERANZAFACILITY NUMBER:
197800744
ADMINISTRATOR:JOSE GOMEZFACILITY TYPE:
772
ADDRESS:11925 1/4,1/2 11931 ELLIOTT AVTELEPHONE:
(626) 350-5304
CITY:EL MONTESTATE: CAZIP CODE:
91732
CAPACITY: 13CENSUS: 12DATE:
12/14/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
03:16 PM
MET WITH:Melanie Gudino, Supervisor TIME COMPLETED:
04:40 PM
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Licensing Program Analyst (LPA) Cynthia Chan conducted the required annual inspection on 12/14/23. LPA arrived unannounced and met with Residential Supervisor, Melanie Gudino. The reason for the visit was explained. The facility is licensed as a social rehabilitation facility to serve mentally disabled adults with a capacity of 13 and ambulatory only. There are currently 12 clients residing at the facility.

LPA utilized the Compliance and Regulatory Enforcement (CARE) tools to inspect the facility.
Infection Control: Staff are continuing to clean and disinfect each day. They are using appropriate hand hygiene and wearing gloves when necessary to assist clients. The facility has submitted the Infection Control Plan.
Physical Plant & Environment Safety: The facility consists of individual units: Unit #9 consists of 2 client bedrooms, 1 bathroom, and common areas; Unit #3 consists of 2 client bedrooms, 1 bathroom, common areas, and a staff office next door; Unit #8 consists of 2 client bedrooms, 1 bathroom, living room, and kitchen; Unit #4 is an individual client room with a private bathroom; Unit #5 is a library; Unit #6 is utilized as the staffing offices; and the Wellness room is utilized for individual sessions. There are smoke and carbon monoxide combo detectors located in each unit. Cleaning solutions and disinfectants are locked and inaccessible to clients.
Operational Requirements: The facility is adhering to operational requirements. Staff are providing care and supervision to meet the needs of the clients.
Food Service: There are sufficient food supplies of 2-day perishable and a week of non-perishable items. The food is properly stored in the refrigerator. Pesticides and cleaning supplies are kept away from the food preparation areas. Kitchen is kept clean and free from rodents and other vermin.

There are no deficiencies observed during the visit today. LPA will return on a later date to complete the remainder of the domains. An exit interview was held and a copy of this report was given to the supervisor.
SUPERVISORS NAME: Tony Vasallo
LICENSING EVALUATOR NAME: Cynthia D Chan
LICENSING EVALUATOR SIGNATURE: DATE: 12/14/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/14/2023
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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