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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197803031
Report Date: 03/21/2025
Date Signed: 03/21/2025 05:27:05 PM

Document Has Been Signed on 03/21/2025 05:27 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
GREATER LA AC/SC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754
FACILITY NAME:TRI-STAR HOMESFACILITY NUMBER:
197803031
ADMINISTRATOR/
DIRECTOR:		DARWIN BELMONTEFACILITY TYPE:
735
ADDRESS:2266 RALEO AVENUETELEPHONE:
(626) 269-0241
CITY:ROWLAND HEIGHTSSTATE: CAZIP CODE:
91748
CAPACITY: 6CENSUS: 6DATE:
03/21/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:10 AM
MET WITH:Anita Russell, StaffTIME VISIT/
INSPECTION COMPLETED:
01:30 PM
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Licensing Program Analyst (LPA) Cynthia Chan conducted the required annual inspection on 3/21/25. LPA met with Staff, Anita Russell, and explained the reason for the visit. The administrator, Darwin Belmonte, arrived shortly after to assist with the visit. The facility is licensed to serve 6 mentally disabled ambulatory adults ages 18 to 59.

LPA inspected the facility using the Compliance and Regulatory Enforcement (CARE) tools.
The facility has 3 shared client bedrooms, 1 live-in staff room, 2 bathrooms (1 in staff room and 1 communal), living room, dining room, kitchen, and attached garage. The backyard has a shaded area with table and chairs. The hot water temperature was measured within 105-120 degrees F. Knives, sharps, and cleaning supplies are locked in the garage. Extra personal hygiene products are available. There is a carbon monoxide detector in each bedroom and a carbon monoxide detector in the hallway. Staff are continuing to clean and sanitize daily. Sufficient food supplies of 2 day perishable and a week of non-perishables are observed.
There are currently 6 ambulatory adults residing at the facility. LPA reviewed their files and medications. Files are complete and medications are being administered as prescribed by the physician. Clients have access to the internet. There are no clients with a restricted or prohibited health condition. LPA reviewed 3 staff files. The administrator's (Darwin Belmonte) certificate expires on 7/30/26 and HIV/TB certificate was taken on 6/11/24. Staff have current CPR and First Aid certificates.
Facility has the updated Emergency Disaster Plan and is being reviewed annually. Disaster drills are being conducted quarterly.

No deficiencies were issued today. An exit interview was held and a copy of this report was given to the administrator.
SUPERVISORS NAME: Tony Vasallo
LICENSING EVALUATOR NAME: Cynthia D Chan
LICENSING EVALUATOR SIGNATURE: DATE: 03/21/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/21/2025
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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