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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197803718
Report Date: 07/08/2022
Date Signed: 07/08/2022 12:29:29 PM

Document Has Been Signed on 07/08/2022 12:29 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:BEST FRIENDS SOCIAL CENTER INC IIIFACILITY NUMBER:
197803718
ADMINISTRATOR:STEWART, VICTORFACILITY TYPE:
735
ADDRESS:968 E. COLUMBIA AVENUETELEPHONE:
(909) 623-0545
CITY:POMONASTATE: CAZIP CODE:
91767
CAPACITY: 6CENSUS: 4DATE:
07/08/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:10 AM
MET WITH:S-1TIME COMPLETED:
12:45 PM
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 Licensing Program Analyst (LPA) Elizabeth Irra conducted an unannounced Required-1 year visit focusing on COVID-19 Infection Control Practices. LPA met with S-1 and explained the purpose of today's visit.

This is a single story home which consists of a 3 bedrooms, 2 bathrooms, kitchen with a dinning area, living room, laundry room and office.

The following were observed/inspected: .
  • Signs are posted to promote hand washing, cough/sneeze etiquette, and physical distancing were observed.
  • COVID-19 Infection Control Practices (including signs) were observed at the entrance of this facility and throughout the facility.
  • Bathrooms had hand soap and hand sanitizer.
  • PPE and hygiene supplies observed.
  • Sufficient supply of perishable for 2 days and non-perishable foods for 7 days were observed.
  • Per S-1, (3) clients have both vaccines and 1st booster. (1) client only has (1) vaccine and has refused the 2nd vaccine and booster.
  • Per S-1, there are (9) staff total. Breakdown: (7) staff have both vaccines and 1st booster. (2) staff have religious exemptions on file and both staff are tested weekly (S-1 and S-2).
  • Medication reviewed for (3) Clients (C-1, C-3 and C-4). C-2 does not take medication.
  • Clients were be socially distanced according to local public health guidelines.
  • Staff responsible for direct care and supervision will wear masks.

Exit interview conducted, a copy of this report and Appeal Rights were provided to S-1.
SUPERVISORS NAME: Christine Yee
LICENSING EVALUATOR NAME: Elizabeth Irra
LICENSING EVALUATOR SIGNATURE: DATE: 07/08/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/08/2022
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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