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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197802583
Report Date: 03/16/2022
Date Signed: 03/21/2022 10:36:00 PM

Document Has Been Signed on 03/21/2022 10:36 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:SANTOS HOMEFACILITY NUMBER:
197802583
ADMINISTRATOR:LOURDES SANTOSFACILITY TYPE:
735
ADDRESS:11703 JAMES STREETTELEPHONE:
(562) 924-5149
CITY:CERRITOSSTATE: CAZIP CODE:
90703
CAPACITY: 4CENSUS: 4DATE:
03/16/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
02:45 PM
MET WITH:Marhona Amado-Administrator TIME COMPLETED:
04:30 PM
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Licensing Program Analyst (LPA)Christine Wong conducted an unannounced annual required visit. LPA met with DSP Avelina Selisana and explained the reason for the visit. Shortly after, the administrator Marhona Amado arrived and assisted with the visit. LPA used the infection control tool to evaluate the facility. LPA observed the facility plant, COVID-19 procedures and observed food supply. Facility has submitted a mitigation plan and was approved 02/26/2021.

The facility is a single story house and located in a residential neighborhood. The facility consists of living room, dining area, kitchen, four clients bedrooms, two bathrooms, one live in staff room and a detached garage. Each client room has one bed, one chair, drawer, required linen and furniture and sufficient closet space and lighting. The two bathrooms are clean and operational. The hot water temperature in both bathrooms were measured between 118.8 and 119.6 degrees F which is within the Title 22 regulation. The food supply in the kitchen are sufficient for two days perishable and seven days non-perishable. All the appliances are clean and working properly. The common areas such as living room and dining area are clean and have the required furniture. The exit and passage way are free of obstruction. The front and back yard are maintained well. The front yard has shaded area with table and chairs for client to use. All the cleaning supplies and sharp utensils are locked under the sink. The medication are centrally stored and locked in the medication cabinet near the hallway which is inaccessible to the clients. The smoke detectors are located in each client bedroom and common area and inspected and operated well. The carbon monoxide detector is located in the hallway and working properly. The personal hygiene products in the facility are sufficient including soap, toothbrush and tooth paste..etc and located next to the bathroom#2.

Facility is currently following COVID 19 recommendations regarding COVID 19 signs throughout the facility, facility is disinfected every day or as needed or each time client used, the two bathrooms have sufficient soap, paper towels, and signs and PPE supplies are sufficient for more than 30 days.

No deficiency observed during the visit. A copy of the report was provided the administrator Marhona Amado.
SUPERVISORS NAME: Christine Yee
LICENSING EVALUATOR NAME: Christine Wong
LICENSING EVALUATOR SIGNATURE: DATE: 03/16/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/16/2022
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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