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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197802315
Report Date: 11/30/2021
Date Signed: 11/30/2021 01:19:51 PM

Document Has Been Signed on 11/30/2021 01:19 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
CCLD Regional Office, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754
FACILITY NAME:VRAM ADULT FAMILY HOMEFACILITY NUMBER:
197802315
ADMINISTRATOR:LAURETTA, AURAFACILITY TYPE:
735
ADDRESS:2327 HILLVIEW AVE.TELEPHONE:
(323) 721-9618
CITY:MONTEREY PARKSTATE: CAZIP CODE:
91754
CAPACITY: 4CENSUS: 4DATE:
11/30/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:35 AM
MET WITH:Aura Lauretta, licenseeTIME COMPLETED:
01:15 PM
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Licensing Program Analyst (LPA) Cynthia Chan conducted an annual inspection with the focus of the infection control domain. LPA arrived unannounced and met with licensee, Aura Lauretta. The purpose of the visit was explained. The facility is licensed for 4 ambulatory developmentally disabled adults ages 18 through 59 years.

LPA Chan toured the facility with licensee. The following were observed:
* Facility has 3 bedrooms and 2 bathrooms; 2 are shared client bedrooms and 1 bedroom designated for the live-in licensee, living room, dining room, family room, kitchen, a spacious backyard, and a detached garage.
* The facility has a screening area for temperature check and a hand sanitizer dispenser upon entry.
* Knives and disinfectants are stored and locked in cabinet inside the laundry area.
* The hot water temperature is measured between the required range of 105 -120 degrees Fahrenheit.
* There are sufficient food supplies of 2 day perishable and a week of non-perishable.
* Medications are stored and locked in a safe located in the dining room. LPA reviewed medications for 2 clients who are currently taking medication. The medications are being administered as prescribed and observed 30-day supply for each client.
* The fire extinguisher was last inspected on 11/22/21 and is fully charged.
* LPA observed at least 30 days of PPE supplies stored at the facility.

LPA provided technical assistance on the following:
* N95 Fit testing
* CDSS Provider Information Notices

There are no deficiencies observed during the visit today. An exit interview was conducted and a copy of this report along with the LIC9102 Technical Assistance were given to the licensee.
SUPERVISORS NAME: Lisa Hicks
LICENSING EVALUATOR NAME: Cynthia D Chan
LICENSING EVALUATOR SIGNATURE: DATE: 11/30/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/30/2021
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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