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

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198600050
Report Date: 08/18/2021
Date Signed: 08/18/2021 04:20:41 PM

Document Has Been Signed on 08/18/2021 04:20 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:GENUS RESIDENTIAL CAREFACILITY NUMBER:
198600050
ADMINISTRATOR:SARITA E. WELLINGTONFACILITY TYPE:
735
ADDRESS:8356 MAXINE STREETTELEPHONE:
(562) 861-9486
CITY:PICO RIVERASTATE: CAZIP CODE:
90660
CAPACITY: 4CENSUS: 4DATE:
08/18/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Administrator Janice Harrison TIME COMPLETED:
12:00 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 Jose Villalobos conducted an unannounced annual required visit focused on Infection Control. LPA met with Staff, Imelda Sanchez who allowed entry into the facility. Administrator, Janice Harrison, arrived a short time later. The purpose of the visit was discussed.

This is a 1 story structure with 3 bedrooms. 2 bedrooms are designated as client bedrooms, 1 bedroom is designated as a staff room, and 2 bathrooms. Based on the client population being served and the census, at the time of this visit, the facility appears to be operating within the conditions and limitations specified on the license.

The following was observed, reviewed and inspected: LPA was screened upon entry into the facility. Facility has required postings i regards to Infection control. Facility has an approved mitigation plan as of 3/12/21. Each bedroom contained the required furniture and linens as mandated, 2 bathrooms were clean and operational, ample supply of perishable and nonperishable food items, fully stocked first aid kit, water temperature within required temperature limits, sufficient linen supply, trash cans with tight fitting lids, all smoke detectors were operable, last fire drill conducted 8/7/21, fire extinguisher fully charged, front and back yard clean and free of debris.

LPA reviewed the facility postings and observed all required documents, all staff are fingerprint cleared and associated to the facility, LPA reviewed two (2) client and two (2) staff records, all medications and log book reviewed, clients P&I logs reviewed, LPA observed toxins and sharp objects were locked and inaccessible to clients, LPA observed clients activity area, and clients personal hygiene supply.

There were no deficiencies cited Exit interview conducted and a copy of this report was given to Ms. Harrison
SUPERVISORS NAME: Fernando Fierros
LICENSING EVALUATOR NAME: Jose Villalobos
LICENSING EVALUATOR SIGNATURE: DATE: 08/18/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/18/2021
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