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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197803457
Report Date: 04/11/2024
Date Signed: 04/11/2024 03:37:00 PM

Document Has Been Signed on 04/11/2024 03:37 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
CCLD Regional Office, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754
FACILITY NAME:EAST COMMUNITY CARE HOMEFACILITY NUMBER:
197803457
ADMINISTRATOR/
DIRECTOR:		ESTERA L. HELLERFACILITY TYPE:
735
ADDRESS:158 EAST ROADTELEPHONE:
(626) 215-5132
CITY:LA HABRA HEIGHTSSTATE: CAZIP CODE:
90631
CAPACITY: 4CENSUS: 3DATE:
04/11/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:30 PM
MET WITH:Administrator Estera Heller TIME VISIT/
INSPECTION COMPLETED:
03:45 PM
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Licensing Program Analysts (LPAs) Jose Villalobos conducted the unannounced Annual Inspection visit using the Compliance And Regulatory Enforcement (CARE) Tool. LPA met with Administrator Estera Heller and the purpose of the visit was discussed.

1. Infection Control: LPA observed the facility has sufficient PPE supplies. Infection Control Plan was collected and reviewed.

2. Physical Plant and Environmental Safety: The facility is a single story home located in a residential neighborhood. A tour of the single-story facility included: 1 living room, dining area, kitchen, 3 client bedrooms, 2 bathrooms, laundry area (outside), front patio. Client bedrooms had required furniture. Water temperature tested throughout and measured within Title 22 Regulations. Sharps and cleaning supplies were locked and inaccessible to clients in care. LPA inspected the smoke detectors and carbon monoxide detectors are working properly. Passageways, walkways and patio were free of obstruction.

3. Operational Requirements: The facility is licensed for age range 18 through 59 and ambulatory only. The facility is vendorized as Level 4I home with East Los Angeles Regional Center. All clients in the facility are ambulatory which is within the facilities fire clearance. The facility has a shaded area with table and chairs for client to utilize the outdoor activity.

4, Staffing: The facility has a sufficient staffing in the facility.


Continued on LIC 809-C
SUPERVISORS NAME: Fernando Fierros
LICENSING EVALUATOR NAME: Jose Villalobos
LICENSING EVALUATOR SIGNATURE: DATE: 04/11/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/11/2024
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
CCLD Regional Office, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754
FACILITY NAME: EAST COMMUNITY CARE HOME
FACILITY NUMBER: 197803457
VISIT DATE: 04/11/2024
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5. Personnel Records-Training: Personal records centrally stored. LPA inspected six (6) staff files. All staff are background check cleared and associated with the facility. All the staff files have the required Title 22 documents. The administrator is currently pending certification renewal from the Department. The administrator has the updated HIV and TB training certificate.

6. Client's Right - Information: No client in the facility required any postural support at the present time.

7. Food Service: The facility provide three meals a day for the clients. No client is on any modified diet. The facility has ample supply of two days perishable and seven days non perishable food supply in the facility.

8. Client Records/Incident Reports: Client files are centrally stored. LPA reviewed three (3) clients files. Client files are up to date and have required documents.

9. Health Related Services: Medication is centrally stored and locked making them inaccessible to clients in care. LPA reviewed (3) Client Medications. LPA did not observe any medication mismanagement.

10. Incidental Medical Services: No client in the facility has any restricted health condition plan and they are not accepting any client with prohibited health condition.

11. Disaster preparedness: The facility has an updated emergency disaster plan. The last fire/disaster drill was conducted on 1/24/24.

12. Emergency Intervention: They are not using any restraints in the facility.

Per Title 22 Regulations, no deficiencies are being cited on todays visit.

Exit Interview conducted. A copy of the report was provided
SUPERVISORS NAME: Fernando Fierros
LICENSING EVALUATOR NAME: Jose Villalobos
LICENSING EVALUATOR SIGNATURE:

DATE: 04/11/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/11/2024
LIC809 (FAS) - (06/04)
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