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

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197802587
Report Date: 02/18/2025
Date Signed: 02/18/2025 12:44:32 PM

Document Has Been Signed on 02/18/2025 12:44 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:CULLEN HOMEFACILITY NUMBER:
197802587
ADMINISTRATOR/
DIRECTOR:		PENAFRANCIA ORBITAFACILITY TYPE:
735
ADDRESS:14397 CULLEN STREETTELEPHONE:
5626969694
CITY:WHITTIERSTATE: CAZIP CODE:
90604
CAPACITY: 6CENSUS: 4DATE:
02/18/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:40 AM
MET WITH:Minerva Covilla House ManagerTIME VISIT/
INSPECTION COMPLETED:
01:00 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
License Program Analysts (LPA) Luis De Leon conducted an unannounced annual required visit to Cullen Home. LPAs met with house manager Minerva Cobilla. The purpose of today’s visit was explained to facility personnel met during this visit. Later during the visit, Administrator Josephine Cochongco and Michelle Puno co-administrator arrived at facility. Facility is licensed to serve six (6) developmentally disabled adults ages 18 thru 59 years, ambulatory only.

The LPAs use the Compliance & Regulatory Enforcement Tool (CARE) during today’s inspection. The visit consisted as follows:

REVIEW OF FILES
· Client Admission Agreements, Client & Staff files, Staff fingerprint clearance, Medications, Staff First Aid Certificate, Consumer IPPs.

FACILITY PHYSICAL PLANT

· Three (3) client bedrooms and one (1) staff bedroom inaccessible to clients, two (2) bathrooms (only 1 used for clients), detached car garage, shaded outdoor area, living room, kitchen and dining room, and front and back yard.

LPA reviewed three (3) staff files and four (4) client files. Interview was conducted with (1) staff. Clients were not available at time of visit since attending to program activities outside facility.

Report continues on LIC809C...
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 2
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK ASC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754
FACILITY NAME: CULLEN HOME
FACILITY NUMBER: 197802587
VISIT DATE: 02/18/2025
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
26
27
28
29
30
31
32
Observations during facility tour:

· Bedrooms were furnished with a bedframe, dresser, lamps, and chairs. LPAs observed that there was clean linen, bath towels, and personal hygiene with reasonable closet space available for clients.
· Wall and floors are in good repair. Hallways were clean and free of obstructions.
· Kitchen appliances were in working order and clean. There is sufficient two (2) days of perishables and seven (7) day supply of non-perishable.
· Toilets, showers, and water faucets are found in compliance with Title 22 regulations for temperature and function. Restrooms were stocked and clean.
· Proper lightning was observed in bedrooms and common client areas.
· The water temperature was tested and measured. It was found in compliance with Title 22 regulations between 105º and 120º F degrees.
· Sharps are locked in kitchen and inaccessible to clients. Also, chemicals and cleaning supplies are locked and secured inaccessible to clients.
· Smoke detectors were observed in all bedrooms and carbon monoxide detectors was observed in living room around kitchen area. One (1) fire extinguisher was observed and was fully charged with last inspection on 1/8/2025.
· Last fire drill was conducted on 1/18/2025. Last earthquake drill was conducted on 1/18/2025.
· Front and back yards are free of hazards and there were no bodies of water present at facility. Shaded area was available to clients.
· Medication was centrally stored and properly locked. First Aid kit was inspected and in compliance.

No deficiencies were cited per California Code of Regulations, Title 22, Division 6. An exit interview was conducted, and a copy of the report were provided to co-administrator Michelle Puno.
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
LIC809 (FAS) - (06/04)
Page: 2 of 2