<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197803671
Report Date: 07/05/2024
Date Signed: 07/08/2024 10:56:02 AM

Document Has Been Signed on 07/08/2024 10:56 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
CCLD Regional Office, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754
FACILITY NAME:ROBILYN GUEST HOME IIFACILITY NUMBER:
197803671
ADMINISTRATOR/
DIRECTOR:		REYNOLDS, ERLINDAFACILITY TYPE:
735
ADDRESS:16332 ALORA AVENUETELEPHONE:
(562) 916-7728
CITY:NORWALKSTATE: CAZIP CODE:
90650
CAPACITY: 4CENSUS: 4DATE:
07/05/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:45 PM
MET WITH:Vivian GrandpreTIME VISIT/
INSPECTION COMPLETED:
03:30 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
LPA Angelica Rea conducted an unannounced 1 Year Required visit and met with Caregiver Soledad Bernal. LPA Rea explained the purpose of today's visit, and was allowed entry into the facility. LPA Rea was informed that licensee/administrator Erlinda Reynolds has recently passed away. LPA was informed that Ms. Reynolds' daughter, Robilyn Reynolds has obtained an Emergency Approval to Operate, LIC 9118 from Community Care Licensing. LPA Rea obtained a copy of the form, dated 6/19/24 during the visit. LIC 200 has been submitted to the Centralized application Bureau. Ms. Vivian Grandpre facility RN also came to assist with today's visit.

The facility consists of a single story structure that contains a living room, dining room, kitchen, laundry room, backroom with fireplace, 4 client bedrooms & 1 staff bedroom, two bathrooms, one with a tub & one with a shower, a two car attached garage, a front & backyard with a shaded area for client use. Facility has one live in staff.

LPA conducted a tour of the physical plant along with LPA observed the following: comfortable temperature throughout, hallways clean & free of debris, no weapons, ammunition or bodies of water on premises, postings observed, smoke alarm tested & operational, hot water temperature measured at 107.1, in bathroom #1, and 107.4 degrees F in bathroom #2, First Aid Kit Inspected, sufficient linens & hygienes supplies, sufficient cutlery, cups & dishes, observed toxins & sharps storage location, which is kept locked, 2 day perishable & 7 day non perishable food supply observed, fire extinguisher fully charged, emergency disaster drill last conducted on 6/1/24, stored medications observed, MAR's reviewed, staff & client files reviewed.

No deficiencies observed. Exit interview conducted, and a copy of report provided.
SUPERVISORS NAME: Lisa Hicks
LICENSING EVALUATOR NAME: Angelica Rea
LICENSING EVALUATOR SIGNATURE: DATE: 07/05/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/05/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 1