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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198600067
Report Date: 12/16/2022
Date Signed: 12/16/2022 01:51:12 PM

Document Has Been Signed on 12/16/2022 01:51 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
EL SEGUNDO, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754
FACILITY NAME:ANGELICA GUEST HOMEFACILITY NUMBER:
198600067
ADMINISTRATOR:MARCELO E. MENDOZAFACILITY TYPE:
735
ADDRESS:12613 LONG BEACH BLVDTELEPHONE:
(310) 639-4719
CITY:LYNWOODSTATE: CAZIP CODE:
90262
CAPACITY: 48CENSUS: 28DATE:
12/16/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:15 PM
MET WITH:Orlando Magat, Diogenes ValencerinaTIME COMPLETED:
02:15 PM
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On 12/16/2022 at 12:15pm, Licensing Program Analyst (LPA) Perry Scott conducted an unannounced annual required visit with a primary focus on infection control measures. LPA was met by Diogenes Valencerina and Orlando Magat, Administrators, and the purpose of today’s visit was explained. The facility is licensed to serve up to 48 developmentally disabled clients age range 18 through 59; and approved to serve up to 12 non-ambulatory clients. The annual fees for the facility are current.

As part of the inspection, my primary focus was on infection control. LPA observed the facility’s infection control practices: LPA observed a sanitizing station at the facility entrance. PPE supplies are readily available to staff and residents, and additional supplies are stored. Sufficient paper, cleaning, and disinfecting supplies were also observed. The facility has the mandated COVID infection control posters.

There are currently (28) South Central Regional Center consumers in placement. The facility is in a commercial business area, the facility consisted of a lobby, main office, visitor room, TV room, kitchen, dining room, medication room, 24 bedrooms, 17 bathrooms, pantry, and laundry room. There is also a shaded area and indoor/outdoor activity areas for the clients.

LPA and the administrators toured the facility. Client rooms were checked and found to be following the regulations. Beds and bedding were in good condition, adequate lighting provided, storage for client personal belongings was observed. Each room had a dresser, nightstand, table lamps, chair, and beds. Walls and floors were in good repair. Bed linens, comforters, and bath towels were adequately stocked at the time of visit. There are no bodies of water or firearm/ammunition on the premises. Bathrooms were found to be within Title 22 regulations and were clean and operational. The water temperature was within guidelines and measured 108.1 f degrees.

Report continued on LIC809-C
SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Perry Scott
LICENSING EVALUATOR SIGNATURE: DATE: 12/16/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/16/2022
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 2
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754
FACILITY NAME: ANGELICA GUEST HOME
FACILITY NUMBER: 198600067
VISIT DATE: 12/16/2022
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A comfortable temperature is maintained in the facility. LPA observed the facility to be clean and appropriately furnished at the time of visit. Storage areas for personal hygiene, cleaning agents, toxins, and sharps were inaccessible to clients. The kitchen was inspected and there is enough perishable and non-perishable food available for the clients. Fire extinguishers were charged and last serviced on 10/20/2021. Smoke/Carbon Monoxide detectors were operable. The last emergency drill was conducted on 11/03/2022.

During the visit, LPA observed the facility infection control practices. LPA observed screening protocols for visitors, staff and residents, sanitizing stations (Located in common areas and restrooms). LPA observed staff and residents were wearing face coverings and had the required postings posted throughout the facility. LPA observed the facility has a 30-day supply of Personal Protective Equipment (PPE).

LPA advised the Administrator to continuously monitor the Centers for Disease Control (CDC) website and Community Care Licensing (www.cdss.ca.gov) for Provider Informational Notices (PIN) and for any updates relating to COVID-19 guidance.

During today’s visit there were no deficiencies cited.

Exit interview was held and a copy of the facility evaluation report was provided to administrators, Orlando Magat and Diogenes Valencerina.

End of report.

SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Perry Scott
LICENSING EVALUATOR SIGNATURE:

DATE: 12/16/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/16/2022
LIC809 (FAS) - (06/04)
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