198600456-10-5-2021-11-AS-JCAN-C7HTWZ-20211005150622

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 198600456
Report Date: 10/05/2021
Date Signed: 10/05/2021 03:07:03 PM

Document Has Been Signed on 10/05/2021 03:07 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 DR #100
MONTEREY PARK, CA 91754

FACILITY NAME:	HERITAGE BOARD & CARE #2		FACILITY NUMBER:	198600456
ADMINISTRATOR:	MARY GRACE TRINIDAD		FACILITY TYPE:	735
ADDRESS:	2445 PACIFIC AVENUE		TELEPHONE:	(562) 424-1728
CITY:	LONG BEACH	STATE: CA	ZIP CODE:	90806
CAPACITY: 18		CENSUS: 17	DATE:	10/05/2021
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	10:30 AM
MET WITH:	ADMINISTRATOR MARY TRINIDAD		TIME COMPLETED:	01:15 PM

NARRATIVE

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Licensing Program Analyst (LPA) Jose Calderon conducted an unannounced Annual required visit with a primary focus on infection control measures. LPA Calderon was met by Administrator Mary Trinidad and the purpose of today’s visit was explained. The facility is licensed to serve 18 adult behavioral clients.
There are currently 17 residents in care. The facility is a 1-story structure with 11 rooms and 2 bathrooms, front and rear patios, common area with tables, 1 offices and cleaning room.
LPA Calderon and staff toured the physical plant. There is no bodies of water or firearm/ammunition on the premises. All client rooms were checked and are in good condition, adequate lighting provided, storage for client personal belongings was observed. Walls and floors were in good repair. There is adequately PPE stocked at the time of visit. Bathrooms were found to be within Title 22 regulations and were clean and operational. LPA observed the facility to be clean and appropriately furnished at the time of visit. Storage areas for personal hygiene, cleaning agents, toxins, and sharps were not accessible to clients. Smoke detectors were had wires, but only 1 Carbon Monoxide was found in the facility.

During the visit, LPA did not observe any facility infection control practices. LPA did not observe any screening protocols for visitors, staff and residents, or sanitizing stations (Located in common areas and restrooms). LPA observed staff were wearing face coverings, an isolation room is confirmed for the facility. LPA observed the facility has a 30-day supply of Personal Protective Equipment (PPE).

LPA advised the Administrator to continuously monitor the Centers for Disease Control (CDC) website and Community Care Likening Provider Informational Notices (PIN) for any updates relating to COVID-19 guidance.

During today’s visit there was no deficiencies under California code of regulation title 22, division 6, chapter 8.

Exit interview held and a copy of the report was provided to the Administrator Mary Trinidad by hand.

SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Jose Calderon
LICENSING EVALUATOR SIGNATURE:	DATE: 10/05/2021

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/05/2021

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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