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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198600346
Report Date: 01/31/2022
Date Signed: 01/31/2022 04:08:40 PM

Document Has Been Signed on 01/31/2022 04:08 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:FOSTER AVENUE HOMEFACILITY NUMBER:
198600346
ADMINISTRATOR:EILEEN CORREOSFACILITY TYPE:
735
ADDRESS:10953 FOSTER AVENUETELEPHONE:
(562) 627-9612
CITY:NORWALKSTATE: CAZIP CODE:
90650
CAPACITY: 4CENSUS: 4DATE:
01/31/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:07 AM
MET WITH:Rechele GreenTIME COMPLETED:
02:00 PM
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Licensing Program Analyst Nicol Wesley conducted an unannounced Required 1 year inspection at the facility and met with Administrator Rechele Green and Eileen Correos explained the purpose for todays visit. Prior to the visit LPA Wesley conducted a risk assessment for on-site inspections. The facility phone number is 562 863 0928.

During the visit the Infection control domain was used and the following areas were observed/inspected: The facility had all postings at the front entrance, bathrooms, and throughout the facility. Hand sanitizing gel and masks were located at the entry of each room. A Pre screening area with PPE supplies was observed upon entry into the facility.

A tour of the entire physical plant was completed, that included: Living room, Kitchen, Dining room, Office area, 4 Bedrooms, 2 Bathrooms( 1 located in bedroom 3), Unattached Garage(storage), and back yard area(with enclosed patio/shade). Food supply was observed, medications, and medication logs were reviewed. The smoke detectors/carbon monoxide detector are operable. LPA observed two fire extinguisher in the kitchen and office area. The water temperature was tested and measured 115.4 degrees F. Mitigation report was approved on 03/26/2021.

There were no deficiencies cited. A copy of this report was issued during the exit interview
SUPERVISORS NAME: Rebecca Orendain
LICENSING EVALUATOR NAME: Nicol Wesley
LICENSING EVALUATOR SIGNATURE: DATE: 01/31/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/31/2022
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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