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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198600145
Report Date: 10/22/2024
Date Signed: 10/22/2024 02:49:13 PM

Document Has Been Signed on 10/22/2024 02:49 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:BELL GARDENS MANORFACILITY NUMBER:
198600145
ADMINISTRATOR/
DIRECTOR:
MARIA ZUNIGAFACILITY TYPE:
735
ADDRESS:8424 S EASTERNTELEPHONE:
(562) 927-1389
CITY:BELL GARDENSSTATE: CAZIP CODE:
90201
CAPACITY: 141CENSUS: 67DATE:
10/22/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:30 AM
MET WITH:Maria ZunigaTIME VISIT/
INSPECTION COMPLETED:
03:00 PM
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Licensing Program Analyst (LPA) Glenn Trueman made an unannounced visit and was greeted by Administrator Maria Zuniga and explained the reason for the visit.
The purpose of the visit is to complete the required inspection.
LPA toured the facility along with Administrator Maria Zuniga today 10/22/2024 at 10:00 AM and the following was observed:
Facility contains 56 Client Bedrooms dining room, and TV room.
LPA inspected Rooms 3, 4,19,103,105, 122 and 132 and the water temperature measured between 105 F- 120F.
Annual Inspection includes the following Domains:
Infection Control, Physical Plant and Environment Safety, Operational Requirements, Staffing, Personnel Records-Training, Client Rights- Information, Client records- Incident Reports, Food Service, Health related services, Incidental Medical Services, and Disaster Preparedness.
Interviews were conducted with 3 staff and 5 clients. 7 client files were reviewed and 5 staff files were reviewed. All staff were cleared and associated.
Medication was administered per physician's directions and reviewed for 6 clients.
Signage for hand washing and proper sanitizing were posted. Staff have been trained in hand washing.
Licensee maintained an individual admission agreement for each client.
Fire Clearance has been maintained.
Facility had sufficient supply of 2 day perishable and 7 day non-perishables meeting regulations.
Each client has personal rights free from corporal or unusual punishment, infliction of pain, humiliation, ridicule, coercion, threats, mental abuse, or other actions of a punitive nature.
There is an adequate number of direct care staff to support each resident's physical, social, emotional safety and health care needs as identified in his/her current appraisal.
Facility has a sufficient supply of PPE.
No deficiencies. Exit interview conducted.
SUPERVISORS NAME: Wei Siew Ho
LICENSING EVALUATOR NAME: Glenn Trueman
LICENSING EVALUATOR SIGNATURE: DATE: 10/22/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/22/2024
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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