198600523-9-13-2022-11-AS-ASOO-CJ8LJ7-20220913084725

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 198600523
Report Date: 09/12/2022
Date Signed: 09/13/2022 08:47:41 AM

Document Has Been Signed on 09/13/2022 08:47 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
CCLD Regional Office, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754

FACILITY NAME:	COELLO'S RESIDENTIAL CARE		FACILITY NUMBER:	198600523
ADMINISTRATOR:	COELLO, BESSIE L.		FACILITY TYPE:	735
ADDRESS:	4325 WEST 168TH STREET		TELEPHONE:	(310) 292-8425
CITY:	LAWNDALE	STATE: CA	ZIP CODE:	90260
CAPACITY: 6		CENSUS: 3	DATE:	09/12/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	01:44 PM
MET WITH:	Bessie L. Coello, Administrator		TIME COMPLETED:	04:00 PM

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Licensing Program Analyst (LPA) Ana Soto conducted an unannounced Annual inspection visit and infection control inspection to the above facility. LPA was met by Silma Ardon, Care giver and let met with Bessie L. Coello, Administrator and the purpose of today’s visit was explained.

There are currently (3) West-side Regional Center consumers in placement. All (3) clients are ambulatory. The facility is a single-story structure located in a residential neighborhood. It is the back house of a duplex complex. It consists of the following: 3 bedrooms, 2 bathrooms, Living room/office, kitchen, dining room, shaded area, indoor and outdoor activity area, laundry area, and attached garage.

LPA and Administrator toured the entire facility inside and out. Documents are posted as mandated by the DPH and CCLD. Bedrooms 1- 3 are occupied by clients and contain the mandated furniture.. The (2) bathrooms are clean and operational. Smoke detectors and carbon monoxide detector comply and operational. No firearms are stored at facility and no bodies of water present. Medications are stored, locked and inaccessible to clients. 1 staff file is current, 1 resident file is current along with medications. The water temperature is at 108.7 degrees. A comfortable temperature is maintained in the facility. Ample supply of perishable and nonperishable food, linens and personal hygiene supplies are adequate, hazardous toxins and/or items are inaccessible to clients, (1) fire extinguishers are fully charged. First Aid kit complete and with manual. Exit, walkways and/or passageways, front and back yard are free of debris and/or hazards. The facility is in good repair.

SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Ana Soto
LICENSING EVALUATOR SIGNATURE:	DATE: 09/12/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/12/2022

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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754

FACILITY NAME: COELLO'S RESIDENTIAL CARE	FACILITY NUMBER: 198600523
	VISIT DATE: 09/12/2022

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During the visit, LPA observed the facility infection control practices. LPA observed a sanitizing station at the facility entry & visitors and temperatures are logged and checked, sanitizer/soap in all the bathrooms (paper towel are not in bathrooms due to clients behaviors) and additional sanitation supplies are stored in a cabinet and living room. LPA observed staff wearing masks, resident private rooms will be converted to isolation rooms (if needed) trash cans with lids, cart for PPE’s, mitigation plan posted and/or in folder, Fit testing not completed for staff. Required postings throughout the facility. Visitor designated area, facility has internet & IPAD for clients to use, clients temperatures are checked and logged (once a day). No emergency contacts posted; PPE's are enough for 30 days.

According to the California Code of Regulations (Title 22, Division 6, Chapter 8), LPA did not observe any deficiencies, therefore no citations were issued at this time.

Technical Advisory (TA) issued:

1. No fit testing for N95 completed for staff.
2. Emergency contacts not posted.

An exit interview conducted with Bessie Coello's, Administrator.

Due to technical difficulties (printer not working) reports will be provided via email.

SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Ana Soto
LICENSING EVALUATOR SIGNATURE:	DATE: 09/12/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/12/2022

LIC809 (FAS) - (06/04)

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