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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198600314
Report Date: 03/17/2025
Date Signed: 03/18/2025 08:13:44 AM

Document Has Been Signed on 03/18/2025 08:13 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK ASC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754
FACILITY NAME:HOUSE ON GARO, THEFACILITY NUMBER:
198600314
ADMINISTRATOR/
DIRECTOR:
STALLCUP-DOBRENEN, CARRIEFACILITY TYPE:
735
ADDRESS:15463 GARO STREETTELEPHONE:
(626) 369-0099
CITY:HACIENDA HEIGHTSSTATE: CAZIP CODE:
91745
CAPACITY: 6CENSUS: 4DATE:
03/17/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:04 PM
MET WITH:Racheal Baez- DSPTIME VISIT/
INSPECTION COMPLETED:
02:47 PM
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Licensing Program Analyst (LPA) S Vaid conducted an unannounced annual required visit. LPA Vaid met with DSP Rachael Baez and explained the reason for the visit, and House Manager, Nicholas Baez arrived shortly after an assisted with the visit. LPA used the CARE tool to evaluate the facility. The facility services for four (4) ambulatory clients, serviced by Pomona Regional Center. LPA observed the facility plant, food supply, medications and clients/staff files.

The facility is a one-story house, located in the rear of the property. The facility is comprised of a living room, dining area, kitchen, four clients’ bedrooms, one client bathroom is share by two clients, the other bedrooms have one (1) client each. Facility has two (2) bathrooms, one bathroom is shared by three clients, one private bathroom for one client. 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 107.9- 114.5 F, which is within Title 22 regulation. The food supply, 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 well maintained and has a shaded area for clients. 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 and are interconnected. The medication is centrally 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. The facility bathrooms have sufficient soap, paper towels, and wash hand sign. Sufficient PPE supplies are stored in garage.
Four (4) clients files were reviewed, and two (2) staff files were reviewed. Administrator certificate expires 08/31/25, fire drills are held monthly last drill was 03/03/25.

No deficiencies were found during this visit. Exit interview was conducted with House Manager Nicholas Baez and a copy of this report was provided.
SUPERVISORS NAME: Fernando Fierros
LICENSING EVALUATOR NAME: Sanjay Vaid
LICENSING EVALUATOR SIGNATURE: DATE: 03/17/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/17/2025
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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