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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198600050
Report Date: 09/15/2022
Date Signed: 09/15/2022 03:21:41 PM

Document Has Been Signed on 09/15/2022 03:21 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:
09/15/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:40 AM
MET WITH:Administrator Janice Harrison TIME COMPLETED:
11:00 AM
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Licensing Program Analyst (LPA) Jose Villalobos made and unannounced Annual inspection focused on Infection Control. On today’s visit LPA met with Administrator Janice Harrison and 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 8/2/22, 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 four (4) client and two (2) staff records, all medications and log book reviewed. LPA observed toxins and sharp objects were locked and inaccessible to clients, LPA observed clients activity area, and clients personal hygiene supply. Exits/ Walkways around the home were free of debris and hazards. LPA completed visit with the Inspection Tool focused on Infection Control.

There were no deficiencies cited. Exit interview conducted and a copy of this report was provided.
SUPERVISORS NAME: Fernando Fierros
LICENSING EVALUATOR NAME: Jose Villalobos
LICENSING EVALUATOR SIGNATURE: DATE: 09/15/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/15/2022
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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