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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197801456
Report Date: 02/17/2023
Date Signed: 02/24/2023 09:10:10 AM

Document Has Been Signed on 02/24/2023 09:10 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
GREATER LA AC/SC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754
FACILITY NAME:FILIPINAS CARE HOMEFACILITY NUMBER:
197801456
ADMINISTRATOR:CORPUZ, DANIELFACILITY TYPE:
735
ADDRESS:18422 SEADLER DRTELEPHONE:
(626) 789-7157
CITY:ROWLAND HEIGHTSSTATE: CAZIP CODE:
91748
CAPACITY: 6CENSUS: 5DATE:
02/17/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
08:30 AM
MET WITH:Mercedez Corpuz TIME COMPLETED:
10:40 AM
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Licensing Program Analysts (LPAs) Christine Wong and Tena Herrera conducted an unannounced annual required visit. LPA's met with Administrator Mercedez and Daniel Corpuz and explained the reason for the visit. LPA's used the infection control tool to evaluate the facility. LPA's observed the facility plant, COVID-19 procedures, reviewed clients'' medications, observed food supply, and reviewed client and staff files.

The facility is a single story house and located in a residential neighborhood area. The facility includes: Living room, dining area, kitchen, three clients bedrooms, one client bathroom, one live in staff room and a detached garage. All 3 clients bedrooms were toured. Each bedroom has two beds, two dresser, two night stand, required bed linen and furniture and sufficient lighting and closet space. The client bathroom is clean, sanitary and in a good working condition. The hot water temperature was tested in the client bathroom is 114.9 degrees F which is within Title 22 regulation. The kitchen cabinet and refrigerator in the garage and house has 2 days perishable and 7 days non perishable food supply. All the appliances in the kitchen are clean and working properly. The common area such as living room and dining area have the required furniture. The front and back yard are maintained well. The back yard has a shaded area with table and chairs for client to utilize. LPAs also inspected the smoke detector and they are all working probably,

LPA's reviewed 5 resident files to confirm emergency contact is updated. LPA's also reviewed 2 staff files to confirm health screenings and fingerprint clearances. Their health screening are updated on their personnel files and they are all fingerprint cleared too. LPA also inspected 5 clients' medication and they are all centrally stored in the kitchen cabinet and inaccessible for the clients and all seemed updated and accurate.
SUPERVISORS NAME: David Sicairos
LICENSING EVALUATOR NAME: Christine Wong
LICENSING EVALUATOR SIGNATURE: DATE: 02/17/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/17/2023
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)
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: FILIPINAS CARE HOME
FACILITY NUMBER: 197801456
VISIT DATE: 02/17/2023
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Facility is currently following COVID 19 recommendations regarding COVID 19 signs throughout the facility, facility is disinfected every day, client's bathrooms have sufficient soap, paper towels, and signs, the PPE supplies is sufficient for more than 30 days.

No deficiencies were observed during the visit.

Exit Interview conducted and a copy of the report was provided to Administrator Mercedez and Daniel Corpuz
SUPERVISORS NAME: David Sicairos
LICENSING EVALUATOR NAME: Christine Wong
LICENSING EVALUATOR SIGNATURE:

DATE: 02/17/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/17/2023
LIC809 (FAS) - (06/04)
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