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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198600558
Report Date: 04/18/2022
Date Signed: 04/18/2022 03:38:54 PM

Document Has Been Signed on 04/18/2022 03:38 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:PALS EINDELIJK EL MONTEFACILITY NUMBER:
198600558
ADMINISTRATOR:GLORIA GALLEGOSFACILITY TYPE:
775
ADDRESS:11645 MCBEAN DR.TELEPHONE:
(626) 279-1064
CITY:EL MONTESTATE: CAZIP CODE:
91732
CAPACITY: 60CENSUS: 23DATE:
04/18/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:50 PM
MET WITH:Manager Melissa AllenTIME COMPLETED:
03:00 PM
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Licensing Program Analyst (LPA) Glenn Trueman made an unannounced visit to the facility and was greeted by Melissa Allen Program Manager and explained the reason for the visit.
The purpose of the visit is to conduct the required Annual Inspection.
LPA toured the facility with Melissa Allen Program Manager at 1:15 PM AM on 4/18/2022 which consisted of the following;
Front office, conference room, supervisor office, manager office, 2 activity rooms , 6 programming rooms, storage room, infirmary, 4 restrooms each with sink and toilet and a kitchen area.
All staff were cleared.
No medications are being administered for the clients currently attending at today's visit.
No meals are being provided by the facility.
Visitation signage was posted along with signage for hand washing and proper sanitizing.
Temperature checks are conducted and logged.
Staff have been trained in hand washing.
Staff are sufficient with no shortages and there is a plan to replace workers if ill.
There are rooms available if isolation is needed. Staff wear masks, gloves and face shields.
Bathrooms have proper signage for hand washing. There are multiple stations for hand sanitizing.
Social distancing is implemented.
Facility has sufficient supply of PPE. Facility has a specific plan to ensure proper cleaning and disinfection of environmental surfaces and laundry; commonly touched surfaces are cleaned and disinfected at least once every shift . Plan when to notify medical provider if symptoms develop or COVID-19 exposure or when to call 911 for severe respiratory distress. No deficiencies.
Exit interview conducted.
SUPERVISORS NAME: Wei Siew Ho
LICENSING EVALUATOR NAME: Glenn Trueman
LICENSING EVALUATOR SIGNATURE: DATE: 04/18/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/18/2022
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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