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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197802808
Report Date: 10/15/2023
Date Signed: 10/15/2023 12:16:11 PM

Document Has Been Signed on 10/15/2023 12:16 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
EL SEGUNDO ASC, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754
FACILITY NAME:BIENNAS HOMEFACILITY NUMBER:
197802808
ADMINISTRATOR:BIENNA LAPUZFACILITY TYPE:
735
ADDRESS:3502 IROQUOIS AVENUETELEPHONE:
(562) 425-5270
CITY:LONG BEACHSTATE: CAZIP CODE:
90808
CAPACITY: 4CENSUS: 3DATE:
10/15/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
07:58 AM
MET WITH:Sonia LapuzTIME COMPLETED:
12:30 PM
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On 10/15/2023, at 08:00 AM, Licensing Program Analyst (LPA) Antonine Richard conducted an unannounced annual visit using the new Care Inspection Tools. LPA was met with Licensee Sonia Lapuz. The facility is licensed for four adult clients with behavioral issues. Currently, there are (3) residents residing in the facility with behavioral issues.

LPA Richard explained to Licensee Lapuz, the purpose of today's visit. LPA and Licensee toured the entire inside and outside facility grounds. As part of the inspection, LPA Richard reviewed: (3) resident service records, (3) resident medication records, (2) staff records, and inspected the inside facility and outside grounds. The facilities’ last fire drill was conducted on 09/25/2023. The two-story residential home consists of (3) resident bedrooms, (2) resident bathrooms, living room, dining room, kitchen, staff room, office area, attached garage with washer and dryer/ storage area, backyard with table and chairs. No weapons are stored in the premises. Kitchen was inspected and observed to be clean and operational. A two-day supply perishable and seven-day supply of non-perishable foods are present in the facility. Emergency Water Storage is in the garage.

LPA Richard observed that all facility rooms are clean and in good repair. A comfortable temperature was observed, and the facility has central air and heating. LPA Richard observed the following during inspection of resident’s rooms: mattresses are in good condition, adequate lighting present, plenty of dresser/closet space is present, and all bed linens present. All bedrooms contain furniture, lighting fixtures and personal storage space as required, all beds have the required amount of linen and mattress covers, LPA observed fully stocked closet with bedding, towels, and toiletries supplies. Bathroom fixtures are clean, in good repair, and working properly and contain the required nonskid mats and grab bars.
SUPERVISORS NAME: Ulysses Coronel
LICENSING EVALUATOR NAME: Antonine Richard
LICENSING EVALUATOR SIGNATURE: DATE: 10/15/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/15/2023
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754
FACILITY NAME: BIENNAS HOME
FACILITY NUMBER: 197802808
VISIT DATE: 10/15/2023
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LPA Richard observed bathrooms were found to be within Title 22 regulation. The hot water temperature tested at 105.9F degrees Fahrenheit. Facility (4) Carbon Monoxide and (5) Smoke Detectors hard wired and connected were tested and are working properly

The facility (5) Fire Extinguishers were checked and found to be fully charged and accessible. All exit doors in the facility have alarm systems. All toxins and knifes are locked/secured and inaccessible to residents. Medications are centrally stored and in a locked storage cabinet. Facility first aid kit is fully stocked with manual was checked and in order. Outside grounds were toured and no bodies of water were observed. All Exits/ Walkways around the home were free of debris and hazards. Outside patio accessible to residents. Three (3) resident files were reviewed and found to be complete. The facility does NOT handle resident's money/cash resources. All the required documents are posted in the facility in a clearly visible area. LPA observed the facility has a 30-day supply of Personal Protective Equipment (PPE).


According to the California Code of Regulations (Title 22, Division 6, Chapter 8),

No deficiencies were cited during inspection visit. A Technical violation was issued, to Licensee Sonia Lapuz at this time. Please see LIC9102-TV

An exit interview was conducted, and a copy of the Facility Evaluation Report was provided to Licensee Sonia Lapuz.

SUPERVISORS NAME: Ulysses Coronel
LICENSING EVALUATOR NAME: Antonine Richard
LICENSING EVALUATOR SIGNATURE:

DATE: 10/15/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/15/2023
LIC809 (FAS) - (06/04)
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