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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197802391
Report Date: 02/16/2023
Date Signed: 02/16/2023 11:46:37 AM

Document Has Been Signed on 02/16/2023 11:46 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
CCLD Regional Office, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754
FACILITY NAME:RIMGROVE RESIDENTIAL CAREFACILITY NUMBER:
197802391
ADMINISTRATOR:LEE FRANCES PORTERFACILITY TYPE:
735
ADDRESS:619 RIMGROVE DRIVETELEPHONE:
(626) 336-2343
CITY:VALINDASTATE: CAZIP CODE:
91744
CAPACITY: 4CENSUS: 4DATE:
02/16/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Angela Porter (Assistant Administrator)TIME COMPLETED:
12:00 PM
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Licensing Program Analyst (LPA) Kruz Long conducted a site visit for the annual inspection. Upon arriving at the facility, LPA met with Angela Porter (Assistant Administrator) who assisted with the visit. The facility is LICENSED TO SERVE FOUR DEVELOPMENTALLY DISABLED ADULTS BETWEEN THE AGES OF 18-59 YEARS.

The facility is located in a residential area. A tour of the single-story facility includes: Living room, dining room, kitchen/laundry, 4 bedroom, 2 bathrooms and an attached garage/storage. All medications for residents are kept locked and inaccessible to other clients. The bathrooms are clean and operational. Clients bedrooms were checked and closet/drawer space to accommodate each resident comfortably was available. The hot water temperature was tested in the bathroom and measured at 118.9 degrees F. The kitchen was observed for the ability to prepare and serve food. Facility maintains a comfortable temperature for clients. LPA observed an appropriate food supply of two (2) days of perishables and one week (7 days) of non-perishables. All storage areas for cleaning solutions, toxins, knives, and hazardous items are in a secured cabinet and inaccessible to clients. Last fire drill was conducted on 11/05/22. LPA reviewed staff files, client records and client medications. The Administrator's certificate is current. Smoke detectors and carbon monoxide detectors are operable and in compliance. The fire extinguisher was observed in the kitchen area and was fully charged. The first-aid kit is fully stocked w/First-aid Manual. A shaded area with chairs is provided in the front yard. The backyard is free of debris/hazards and the outdoor and passageways are free of obstruction. Staff has current first aid and criminal record clearance.

No deficiencies were observed during today's visit.

An exit interview was conducted and a copy of this report was provided to the Angela Porter.
SUPERVISORS NAME: Fernando Fierros
LICENSING EVALUATOR NAME: Kruz Long
LICENSING EVALUATOR SIGNATURE: DATE: 02/16/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/16/2023
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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