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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197802942
Report Date: 03/11/2023
Date Signed: 03/11/2023 11:38:23 AM

Document Has Been Signed on 03/11/2023 11:38 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
GREATER LA AC/SC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754
FACILITY NAME:CITRUS RESIDENTIAL FACILITYFACILITY NUMBER:
197802942
ADMINISTRATOR:VILORIA, MANUELITAFACILITY TYPE:
735
ADDRESS:1329 N. CITRUS AVENUETELEPHONE:
(626) 966-6063
CITY:COVINASTATE: CAZIP CODE:
91722
CAPACITY: 6CENSUS: 6DATE:
03/11/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:05 AM
MET WITH:Manuelita Viloria - Administrator TIME COMPLETED:
11:45 AM
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Licensing Program Analyst(s)(LPA) Mary Flores conducted an unannounced annual visit using the CARE tool at the facility. LPA Flores met with Manuelita Viloria administrator and explain the reason for the visit.

The facility is licensed to serve (6) six ambulatory adults between the ages of 18-59 years old and prefer to serve mentally disable adults. The facility consist of a single home in a residential neighborhood and has (3) three client bedrooms, (3) three staff bedrooms, (1) client bathroom, (1) staff bathroom, a kitchen, (1) staff living/dining room, (1) client living/dining room, an attached garage, a front yard and a backyard with a pool.

LPA Flores toured the facility with Manuelita Viloria - Administrator and observed the following:
Facility is clean and in good repair throughout. Interlace smoke detectors and carbon monoxide detector were tested and in working condition. Living/dining room have sufficient sitting area. (3) three client bedrooms were observed with sufficient lighting, furniture, and bedding supplies. (1) client bathroom was observed in working condition and water temperature was tested at 115.7 degrees F. which is within the required 105-120 degrees F. Staff bedrooms, bathroom, and living/dining room were observed in good repair. Front yard has a shaded sitting area. Backyard has a fenced/covered pool, and shaded sitting area. Kitchen is clean, refrigerators, freezers, and pantry were observed and hold sufficient food supplies for at least (2) days worth of perishables and (7)days of non-perishables. Knives and sharps are locked in a safe box and medication was locked, in a cabinet with a magnetic lock.
LPA reviewed (5) client files and medication. Facility does not handle client's P&I money. LPA reviewed (4) staff files. Last fire drill was conducted on 1/20/23. Administrator certificate was observed for Manuelita Viloria #6005418735 with exp. date: 7/28/23. Interviews were conducted with (2) staff and (5) clients.

No deficiencies were noted during this visit.

Exit interview was conducted with Manuelita Viloria administrator and a copy of this report was provided.
SUPERVISORS NAME: Tony Vasallo
LICENSING EVALUATOR NAME: Mary G Flores
LICENSING EVALUATOR SIGNATURE: DATE: 03/11/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/11/2023
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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