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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198600314
Report Date: 03/01/2022
Date Signed: 03/02/2022 10:22:42 PM

Document Has Been Signed on 03/02/2022 10:22 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:HOUSE ON GARO, THEFACILITY NUMBER:
198600314
ADMINISTRATOR:STALLCUP-DOBRENEN, CARRIEFACILITY TYPE:
735
ADDRESS:15463 GARO STREETTELEPHONE:
(626) 369-0099
CITY:HACIENDA HEIGHTSSTATE: CAZIP CODE:
91745
CAPACITY: 6CENSUS: 5DATE:
03/01/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:35 PM
MET WITH:Brent Miller-DSPTIME COMPLETED:
02:00 PM
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Licensing Program Analyst (LPA) Christine Wong conducted an unannounced annual required visit. LPA met with DSP Brent Miller and explained the reason for the visit and he assisted the LPA with the visit too. LPA used the infection control tool to evaluate the facility. LPA observed the facility plant, COVID-19 procedures and food supply. Facility has submitted a mitigation plan and was approved on 06/04/21

The facility is a one story house and located in the rear of the property and the residential neighborhood. The facility consisted of living room, dining area, kitchen, three clients bedrooms, one live in staff room with a bathroom, one client bathroom. Currently there's no live in staff living in the facility. Client bedrooms were toured and each room has two beds, two drawers, two chairs, required bed linen and sufficient lighting and closet space. The client bathroom is clean and maintained in good condition. The hot water temperature tested between 110.5 and 112.4 degrees F which is within Title 22 regulation. For the food supply, the food in the refrigerator and pantry are sufficient for two days perishable and seven days non-perishable. All the appliances are clean and working properly. The common areas such as living room and dining area are clean and have the required furniture. The back yard is maintained well and has a shaded area and sitting area for clients to use it. The passageway and exits are free of obstruction. Each bedroom and common area has a smoke detector and they are operated well. The carbon monoxide detectors are tested and working properly too. The medication is centrally stored and stored in the hallway storage room which is inaccessible to clients. All the cleaning supplies and sharp utensils are stored in the hallway storage room which is locked and inaccessible to clients too.

Facility is currently following COVID-19 recommendations regarding COVID-19 signs throughout the facility, social distancing and disinfected the facility for every shift or as needed. The facility bathrooms have sufficient soap, paper towels, and wash hand sign. PPE supplies are stored for more than 30 days.

No deficiencies were found during this visit. Exit interview was conducted with DSP Brent Miller and a copy of this report was provided.
SUPERVISORS NAME: Christine Yee
LICENSING EVALUATOR NAME: Christine Wong
LICENSING EVALUATOR SIGNATURE: DATE: 03/01/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/01/2022
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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