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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198600050
Report Date: 06/13/2024
Date Signed: 06/13/2024 12:57:11 PM

Document Has Been Signed on 06/13/2024 12:57 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
GREATER LA AC/SC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754
FACILITY NAME:GENUS RESIDENTIAL CAREFACILITY NUMBER:
198600050
ADMINISTRATOR/
DIRECTOR:
SARITA E. WELLINGTONFACILITY TYPE:
735
ADDRESS:8356 MAXINE STREETTELEPHONE:
(562) 861-9486
CITY:PICO RIVERASTATE: CAZIP CODE:
90660
CAPACITY: 4CENSUS: 4DATE:
06/13/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:17 AM
MET WITH:Janice Harrison, Administrator/licenseeTIME VISIT/
INSPECTION COMPLETED:
01:15 PM
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Licensing Program Analyst (LPA) Cynthia Chan conducted the annual inspection on 6/13/24. LPA arrived unannounced and met with Administrator, Janice Harrison. The purpose for the visit was explained.
The facility is licensed for (4) ambulatory developmentally disabled adults ages 18 to 59. There are currently (4) clients residing at the home and are receiving services through the Eastern Los Angeles Regional Center.
LPA toured the facility and observed the following:
The facility consists of 2 client shared bedrooms, 1 staff room, 2 bathrooms, living room, dining and kitchen. The laundry machines are located in the garage. The spacious backyard is free of obstruction and has a table and chairs for client use. There is also a small storage room in the grass area. Sufficient food supplies of 2 day perishable and a week of nonperishable are observed. The facility is clean and well maintained. Knives and cleaning supplies are locked. Per the administrator, they are continuing to clean and sanitary the facility daily. They have sufficient PPE supplies. There is a carbon monoxide detector in the hallway and the smoke detectors are interconnected. The facility conducts disaster drills every month.
LPA reviewed 3 personnel files. The administrator's (Janice Harrison) certificate expires on 6/25/24. Staff have current CPR and First Aid certificates. They are receiving ongoing training. Staff files contain the following forms: personnel record, health screening, employee rights, and CPR & First Aid certificate.
LPA reviewed 4 client files and medications. Client files have the admission agreement, consent forms, Emergency and Identification form, medical assessment with TB results, current IPP, Safeguards for Property/Valuables and Cash resources. The P&I ledgers were also reviewed. Medications are being given as prescribed and documented. There are no clients with a restricted or prohibited health condition.

There are no deficiencies observed today. An exit interview was held and a copy of this report was given to J. Harrison.
SUPERVISORS NAME: Tony Vasallo
LICENSING EVALUATOR NAME: Cynthia D Chan
LICENSING EVALUATOR SIGNATURE: DATE: 06/13/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/13/2024
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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