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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198204954
Report Date: 06/13/2022
Date Signed: 06/13/2022 03:40:28 PM

Document Has Been Signed on 06/13/2022 03:40 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 DR #100
MONTEREY PARK, CA 91754
FACILITY NAME:ELEGANT CARE VILLA D-1FACILITY NUMBER:
198204954
ADMINISTRATOR:IRENEO ALIPIOFACILITY TYPE:
740
ADDRESS:2741 N. BELLFLOWER BLVD.TELEPHONE:
(714) 606-1087
CITY:LONG BEACHSTATE: CAZIP CODE:
90815
CAPACITY: 6CENSUS: 4DATE:
06/13/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
02:20 PM
MET WITH:Joy AleopioTIME COMPLETED:
03:45 PM
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On 06/13/22 Licensing Program Analyst (LPA) Jade Jordan conducted an unannounced Annual Inspection visit with an emphasis on infection control. LPA was met by Joy, Administrator and the purpose of today’s visit was explained.

There are currently (4) Four Regional Center consumers in placement. Of which 2 clients are Non-ambulatory. The facility is a single story structure located in a residential neighborhood. It consists of the following: 4 bedrooms, 3 bathrooms, living room, kitchen, dining room, laundry area, and detached garage.

LPA and Administrator toured the entire facility inside and out. Documents are posted as mandated by the DPH and CCLD. Bedrooms 1, 2, 3, 4 are occupied by clients and contain the required furniture. The (3) bathrooms are clean and operational. Smoke detectors and carbon monoxide detector were in compliance and operational. Medications are stored, locked and inaccessible to clients. Medications are current. LPA observed Client Files to be current, and have all the required documentation. A comfortable temperature is maintained in the facility. Water is measured at 116.Degree's. An Ample supply of perishable and nonperishable foods were observed. Linens and personal hygiene supplies are adequate. hazardous toxins and/or sharp items are inaccessible to clients, 1 fire extinguisher are fully charged. Exit, walkways and/or passageways, to the front and back yard are free of debris and/or hazards. No firearms are stored at facility and no bodies of water present. The facility is in good repair.

SUPERVISORS NAME: Ulysses Coronel
LICENSING EVALUATOR NAME: Jade Jordan
LICENSING EVALUATOR SIGNATURE: DATE: 06/13/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/13/2022
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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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 DR #100
MONTEREY PARK, CA 91754
FACILITY NAME: ELEGANT CARE VILLA D-1
FACILITY NUMBER: 198204954
VISIT DATE: 06/13/2022
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During the visit, LPA observed the following infection control practices:

Sanitizing station upon entry, Covid postings outside the door, sanitizer/soap paper towels in the in bathrooms. Additional sanitation supplies in a locked cabinet located in the office. Each individual room can be designated for isolation. Required postings throughout the facility. The facility has an approved Mitigation plan. Visitors are logged and checked. When clients leaves the facility, vitals are checked and logged 1x a day, if no symptoms are present. Over 30 day supply of PPE was observed.



No Deficiencies were observed during this visit. An exit interview was conducted, and a copy of this report was provided.
SUPERVISORS NAME: Ulysses Coronel
LICENSING EVALUATOR NAME: Jade Jordan
LICENSING EVALUATOR SIGNATURE:

DATE: 06/13/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/13/2022
LIC809 (FAS) - (06/04)
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