<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197802586
Report Date: 02/18/2025
Date Signed: 02/18/2025 02:15:45 PM

Document Has Been Signed on 02/18/2025 02:15 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
MONTEREY PARK ASC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754
FACILITY NAME:COLIMA HOMEFACILITY NUMBER:
197802586
ADMINISTRATOR/
DIRECTOR:		PENAFRANCIA ORBITAFACILITY TYPE:
735
ADDRESS:11039 COLIMA ROADTELEPHONE:
(562) 941-8264
CITY:WHITTIERSTATE: CAZIP CODE:
90604
CAPACITY: 6CENSUS: 2DATE:
02/18/2025
TYPE OF VISIT:Case Management - Annual ContinuationUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:40 PM
MET WITH:Michelle Puno Co-AdministratorTIME VISIT/
INSPECTION COMPLETED:
02:30 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
Licensing Program Analyst (LPA) Luis De Leon conducted an annual continuation visit to complete the annual inspection which was not completed due to time constraint. LPA met with co-Administrator Michelle Puno and explained the reason for the visit. The initial annual visit was conducted on 02/14/25. During the initial visit the following inspection was done tour of physical plant, food supply, first aid, smoke & carbon monoxide detectors, facility operation, sharps, cleaning supplies, linens, personal hygiene, and client and staff files.

During today's visit, LPA continued the annual visit. LPA reviewed two (2) client medications. Medications are kept in cabinets located in the office next to kitchen inaccessible to clients. Medications are documented properly and given as prescribed. In addition, co-Administrator provided copies of facility sketch, Infection Control Plan, and Emergency and Disaster plan. Clients were attending day program; therefore, client interviews were not done during visit.

Per California Code of Regulations, Title 22, and California Health and Safety Code, there were no deficiencies observed during today's continuation visit. Exit interview held and a copy of the report was provided.
SUPERVISORS NAME: Fernando Fierros
LICENSING EVALUATOR NAME: Luis DeLeon
LICENSING EVALUATOR SIGNATURE: DATE: 02/18/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/18/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 1