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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198600484
Report Date: 03/01/2022
Date Signed: 03/02/2022 10:22:12 PM

Document Has Been Signed on 03/02/2022 10:22 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:MANAGUA CAREFACILITY NUMBER:
198600484
ADMINISTRATOR:HELLER, ESTERA L.FACILITY TYPE:
735
ADDRESS:2515 MOUNTAIN BROOK DRIVETELEPHONE:
(626) 333-0402
CITY:HACIENDA HEIGHTSSTATE: CAZIP CODE:
91745
CAPACITY: 5CENSUS: 5DATE:
03/01/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:15 AM
MET WITH:Estera Heller-Administrator TIME COMPLETED:
12:30 PM
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Licensing Program Analyst (LPA) Christine Wong conducted an annual required visit. LPA met with DSP Carolyne Kebaso and explained the reason for the visit. Shortly after, the administrator Estera Heller arrived and assisted with the visit. LPA used the infection control tool to evaluate the facility. LPA observed the facility plant, COVID-19 procedures and food supply. Facility has submitted a mitigation plan and was approved on 06/25/21.

The facility is located at the residential neighborhood. The facility consisted of living room, dining area, kitchen, common area, four clients bedrooms, two bathrooms, laundry room and attached garage. Client bedrooms were toured. Clients Bedroom#1 to #3 have one single bed, dresser, night stand, required furniture and linen, sufficient lighting and closet space. Client Bedroom#4 has two beds, two dresser, closet, required furniture and linen and sufficient lighting. All clients bathrooms are clean and maintained in good condition. The hot water temperature tested between 115 and 116.1 degrees F which is within Title 22 regulation. For the food supply, the refrigerator in the kitchen and garage has sufficient two days perishable food and seven days non-perishable food. 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 has a shaded area and sitting area. 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 too. The medication is centrally stored and stored in the kitchen cabinet which is inaccessible to clients.

Facility is currently following COVID-19 recommendations regarding COVID-19 signs throughout the facility, social distancing and disinfected the facility for every few hours or as needed. The facility bathrooms have sufficient soap, paper towels, and sign. PPE supplies are stored for more than 30 days.

No deficiencies were found during this visit. Exit interview was conducted with administrator Estera Heller and a copy of this report was provided.
SUPERVISORS NAME: Christine Yee
LICENSING EVALUATOR NAME: Christine Wong
LICENSING EVALUATOR SIGNATURE: DATE: 03/01/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/01/2022
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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