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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198600265
Report Date: 09/20/2022
Date Signed: 09/20/2022 12:26:59 PM

Document Has Been Signed on 09/20/2022 12:26 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:ERNIE'S PLACEFACILITY NUMBER:
198600265
ADMINISTRATOR:LAN LYFACILITY TYPE:
735
ADDRESS:630 N. NICHOLSONTELEPHONE:
(626) 280-7205
CITY:MONTEREY PARKSTATE: CAZIP CODE:
91755
CAPACITY: 6CENSUS: 6DATE:
09/20/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:50 AM
MET WITH:Saundra Sahagun, AdministratorTIME COMPLETED:
12:35 PM
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Licensing Program Analyst (LPA) Cynthia Chan conducted the annual inspection with the focus of the Infection Control domain. LPA arrived unannounced and met with Noey Garcia, the Associate Director. Administrator, Saundra Sahagun, arrived shortly thereafter to assist with the visit.

The facility is licensed for six Developmentally Disabled adults, from 18-59 years old and is approved for 3 ambulatory and 3 non-ambulatory adults. This facility is vendorized through the Eastern Los Angeles Regional Center.

LPA Chan toured the facility and observed/inspected the following:
* On the first floor, there are 6 Client bedrooms, each having their own and a staff office. Clients only reside on the first floor. There are 3 bathrooms, living room/dining area, kitchen, and a laundry room. The second floor has 3 rooms and a bathroom, which are occupied as a supply storage room, Administrator's office, and the Health Care Coordinator's office. There is a detached garage used as storage.
* There are no bodies of water or pool at the facility. No items obstructing the walkways.
* A table is set up outside the front door to screen staff/visitors for COVID-19 symptoms.
* COVID-19 signage are posted at the front door and throughout the facility. All the bathrooms also have hand washing posters.
* The hot water temperature in the bathrooms were measured within the required range of 105-120 degree F.
* Disinfectants and cleaning solutions are stored and locked in the laundry room. Extra supplies of cleaning products are stored in the locked garage. Knives are locked in the kitchen cabinet.
* LPA observed sufficient food supplies of 2-day perishable and a week of nonperishable.
* All staff wore a face mask. Sufficient supply of PPEs were observed at the facility.
* Medications were reviewed for all 6 clients and are being administered as prescribed.
No deficiencies issued on the visit today. An exit interview was conducted and a copy of this report was given to the Administrator.
SUPERVISORS NAME: Lisa Hicks
LICENSING EVALUATOR NAME: Cynthia D Chan
LICENSING EVALUATOR SIGNATURE: DATE: 09/20/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/20/2022
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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