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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197803457
Report Date: 04/28/2023
Date Signed: 04/28/2023 01:47:04 PM


Document Has Been Signed on 04/28/2023 01:47 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:EAST COMMUNITY CARE HOMEFACILITY NUMBER:
197803457
ADMINISTRATOR:ESTERA L. HELLERFACILITY TYPE:
735
ADDRESS:158 EAST ROADTELEPHONE:
(626) 215-5132
CITY:LA HABRA HEIGHTSSTATE: CAZIP CODE:
90631
CAPACITY:4CENSUS: DATE:
04/28/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:45 AM
MET WITH:Estera Heller - LicenseeTIME COMPLETED:
02:00 PM
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Licensing Program Analyst (LPA) Luis Mora conducted an unannounced annual visit at the facility using the CARE Tool. LPA Mora met with Estera Heller (Licensee) and explained the reason for the visit. The facility is licensed to serve four ambulatory clients ages 18 to 59. he facility is operating within the scope of its license.

A tour of the single-story facility included: 1 living room, dining area, kitchen, 3 client bedrooms, 2 bathrooms, laundry area (outside), front patio. LPA Mora conducted the tour with Estera Heller and observed the following: sufficient food supplies for at least 2 days of perishables and 7 days of non-perishables were observed in the kitchen. Sharps were observed locked in the medication cabinet. Chemical and cleaning solutions are kept locked under the kitchen sink. Medications are kept locked in a kitchen cabinet. The First Aid kit is kept locked in the medication cabinet and it is fully stocked with all required items including a current manual. Clean towels and extra linen were observed in the hallway cabinet. Dining and living room have sufficient lighting and sitting area. All bedrooms have all required furniture, lighting, and bedding. Both bathroom showers were observed with non-skid material. The water temperature was tested and measured at 113.1 degrees F in both bathrooms which is within the required 105-120 degrees F. There is a fire extinguisher in the kitchen and it is fully charged. Smoke detectors were observed throughout the facility and were operable during the visit. There are 2 carbon monoxides in the living room and hallway. The front patio clean. There is a shaded seating area in the front patio. No bodies of water were observed at the facility. Passageways and exits are free of obstruction.

LPA reviewed medication for all four clients. Medications are documented properly and given as prescribed. LPA reviewed P&I funds for all 4 clients and observed no discrepancies. LPA reviewed 4 client files and 6 staff files. No 2:were observed with the files. LPA interviewed 2 clients and 3 staff.

Per California Code of Regulations, Title 22, and California Health and Safety Code, there was no deficiencies observed during the visit. Exit interview held and a copy of the report was provided.
SUPERVISOR'S NAME: Wei Siew HoTELEPHONE: (323) 981-3969
LICENSING EVALUATOR NAME: Luis MoraTELEPHONE: 323-981-3964
LICENSING EVALUATOR SIGNATURE:
DATE: 04/28/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/28/2023
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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