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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198600336
Report Date: 02/04/2025
Date Signed: 02/04/2025 03:06:08 PM

Document Has Been Signed on 02/04/2025 03:06 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
MONTEREY PARK ASC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754
FACILITY NAME:CONWELL RESIDENTIAL FACILITYFACILITY NUMBER:
198600336
ADMINISTRATOR/
DIRECTOR:		REYES, MANUELITA V.FACILITY TYPE:
735
ADDRESS:4656 NORTH CONWELL AVENUETELEPHONE:
(626) 332-0190
CITY:COVINASTATE: CAZIP CODE:
91722
CAPACITY: 6CENSUS: 6DATE:
02/04/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:30 AM
MET WITH:Manuelita Reyes, AdministratorTIME VISIT/
INSPECTION COMPLETED:
02:30 PM
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Licensing Program Analyst (LPA) Sanjay Vaid conducted an announced annual inspection. LPA was allowed entry by Rebecca Viloria. Facility Administrator, Manuelita Reyes, arrived shortly after to assist with this inspection. LPA explained the purpose of today's visit.

The facility is licensed for mentally ill clients ages 18-59. The fire clearance is approved for (6) ambulatory clients.

1.Infection Control: The facility staff are using appropriate hand hygiene and wearing gloves while assisting clients. Staff are cleaning and disinfecting often for high traffic surfaces. Facility has sufficient PPE supplies, has an Infection Control Plan and Mitigation Plan. Facility has COVID-19 signage posted throughout the facility. Bathrooms have hand washing signs, soap, and paper towels. Facility Administrator is adhering to infection control requirements.
Per Facility Administrator all (5) clients and all staff have COVID-19 vaccines including boosters.
2.Physical Plant & Environment Safety: This facility consists of (4) bedrooms (1 of which is a staff bedroom), (2) bathrooms (one of which is located inside the staff's bedroom), living room, kitchen, dining area, shaded back patio area and attached garage. Smoke alarms/ carbon monoxide were tested and operable. Fire extinguisher appeared to be full. Knives, cleaning solutions, and disinfectants are locked and inaccessible to clients. Hot water supply measured 105-120*F in the bathrooms, and kitchen.
3.Operational Requirements: The fire clearance is approved for (6) ambulatory clients. Last Fire Drill 01/07/25 and Earthquake Drill: 12/23/24. Per Facility Administrator, these drills are completed every (3-6) months and is adhering to operational requirements.
4.Staffing: There is sufficient staffing at the facility. Administrator Certificate for Manuelita Reyes expires on 07/09/25. Staff employed are over the age of 18 and are fingerprint cleared and associated to the facility.

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SUPERVISORS NAME: Fernando Fierros
LICENSING EVALUATOR NAME: Sanjay Vaid
LICENSING EVALUATOR SIGNATURE: DATE: 02/04/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/04/2025
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK ASC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754
FACILITY NAME: CONWELL RESIDENTIAL FACILITY
FACILITY NUMBER: 198600336
VISIT DATE: 02/04/2025
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5.Personnel Records-Training: Staff files are maintained at the facility. LPA reviewed staff files for Facility Administrator, and S1 and staff have current CPR/first aid training and sufficient on-going training requirements are being met. Staff have their Health Screening and Tuberculosis Screening on file. Staff are also trained on Abuse Reporting.
6.Client Rights-Information: Client personal rights and House Rules are posted. Facility provides wi-fi services to all clients’ which clients utilize through their personal cell phone.
7.Client Records-Incident Reports: LPA reviewed Client files for C-1 through C-5. Client files are maintained at the facility and have the following documents in their files - Admission Agreements, Identification & Emergency Information, Physician's Report (including T.B and Ambulatory Status), Consent for Medical Treatment, Appraisal Needs and Services Plan, Functional Capabilities Assessment, Mental Health Intake Assessment, Client Cash Resources, Special Incident Reports, Client Personal Property and Clients Personal Rights.
8.Food Service: There are sufficient food supplies of 2-day perishable and a week of non-perishable items. The food is properly stored in the refrigerator. There are no special diets. Pesticides and cleaning supplies are kept away from the food preparation areas. Kitchen is kept clean and free from rodents and other vermin. Utensils are clean and stored properly.
9.Health Related Services The medications are centrally stored and in their original containers. LPA reviewed medication for C-1 through C-5. The facility uses the Medication Administration Record (MAR) log to document medications given. Medications are administered as prescribed by the Physician.
10.Incidental Medical Services: Per Facility Administrator, there are no clients at this home with incidental medical services nor have a restricted health condition.
11.Disaster Preparedness: The facility has an Emergency Disaster Plan readily accessible.
12.Emergrency Intervention : Not-Applicable.

No deficiencies noted. Exit interview, appeals rights and a copy of this report was provided to Manuelita Reyes.
SUPERVISORS NAME: Fernando Fierros
LICENSING EVALUATOR NAME: Sanjay Vaid
LICENSING EVALUATOR SIGNATURE:

DATE: 02/04/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/04/2025
LIC809 (FAS) - (06/04)
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