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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198600314
Report Date: 03/12/2024
Date Signed: 03/12/2024 03:49:41 PM

Document Has Been Signed on 03/12/2024 03:49 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: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: 4DATE:
03/12/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:55 PM
MET WITH:House Manager Nick Baez TIME COMPLETED:
04:00 PM
NARRATIVE
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Licensing Program Analyst (LPA) Jose Villalobos conducted an unannounced Required- 1 year visit using the full Care Compliance and Regulatory Enforcement (CARE) Tools. LPA met with House Manager Nick Baez and the purpose of the visit was discussed. The following (CARE) tool domains were utilized during todays inspection:

Operational Requirements:
  • A current Plan of Operation was reviewed.
  • Facility operating within the fire clearance of (6) Clients of which 2 can be non ambulatory .

Physical Plant/Environment Safety:
  • The facility is located in a residential area. The facility has 4 bedrooms, 2 bathrooms, living room, dining area, kitchen, and attached garage
  • The physical plant was inspected. Exit doors are free of any obstruction and there are no pools or large bodies of water. Cleaning supplies and toxic substances are inaccessible to clients
  • Fire Alarms were inspected. Fire extinguishers Observed
  • Water temperature readings measured within the required 105 - 120 degrees Fahrenheit.

Client Rights-Information
  • No postural Supports Observed
  • Internet source provided to clients in care. Required postings observed.

Food Service:
  • Sufficient food supply is stored in the kitchen and pantry areas consisting of: 2-day perishables, 7-day non-perishables, and emergency food supplies observed.
  • Sanitation practices and kitchen cleanliness was observed.
LPA to continue Inspection at a later date as (8) of (12) domains are still needed. No deficiencies are being cited. Exit Interview Conducted and a copy of this report was provided.
SUPERVISORS NAME: Fernando Fierros
LICENSING EVALUATOR NAME: Jose Villalobos
LICENSING EVALUATOR SIGNATURE: DATE: 03/12/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/12/2024
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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