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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197802778
Report Date: 07/12/2022
Date Signed: 07/12/2022 10:30:56 AM

Document Has Been Signed on 07/12/2022 10:30 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:ELLETT RESIDENTIAL FACILITYFACILITY NUMBER:
197802778
ADMINISTRATOR:ELLETT, LESTER WAYNEFACILITY TYPE:
735
ADDRESS:8242 CATALINA AVENUETELEPHONE:
(562) 789-0545
CITY:WHITTIERSTATE: CAZIP CODE:
90602
CAPACITY: 4CENSUS: 1DATE:
07/12/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:01 AM
MET WITH:Lester Ellett, AdministratorTIME COMPLETED:
10:35 AM
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Licensing Program Analyst (LPA) Galarza conducted an unannounced Required- 1 year visit focusing on COVID-19 Infection Control Practices. LPA met with staff Kathy Ellet and explained the purpose of the visit. Administrator Lester Ellett arrived shortly after. There is one (1) level 3 ambulatory developmentally disabled client in the home. The facility is a single story home licensed for 4 ambulatory clients located in a residential neighborhood. It consists of 3 client bedrooms, 1 staff bedroom, 3 bathrooms, dining room, kitchen, living room, den, outdoor patio and detached garage. The last emergency disaster drill was conducted on 7/1/2022.. Administrator certificate expires March 24, 2023.

The facility is a owner operated single story home located in a residential neighborhood that is licensed for 6 ambulatory only clients. LPA conducted an exterior and interior physical plant tour.

Observations:
  • COVID-19 Infection Control signs were observed in the entrance and bathrooms. Screening
  • Bedroom #1 is designated as the COVID-19 isolation room if needed.
  • One (1) centrally stored resident medication record was reviewed. Facility maintains a 30-day supply of medications. Centrally stored medications are kept in a locked closet.
  • Client in care does not wear a mask because it is not tolerated due to cognitive impairment.
  • Sharps and chemicals/cleaning supplies are stored inaccessible to residents.
  • Sufficient supply of perishable for 2 days & non-perishable foods for 7 days were observed.
  • A posted Emergency Disaster Plan was observed.
  • Smoke detectors were tested and are operational. Fire extinguishers are fully charged.
  • Sufficient supply of Personal Protective Equipment (PPEs) was observed.
  • Staff and resident files were not reviewed during today's visit.
  • Outdoor and indoor passageways and exit doors are free of debris and obstruction.
No deficiencies were cited.

Exit interview was conducted with Administrator Ellett Lester. A copy of the report was issued.
SUPERVISORS NAME: Lisa Hicks
LICENSING EVALUATOR NAME: Noemi Galarza
LICENSING EVALUATOR SIGNATURE: DATE: 07/12/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/12/2022
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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