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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198600579
Report Date: 10/28/2024
Date Signed: 10/28/2024 04:28:50 PM

Document Has Been Signed on 10/28/2024 04:28 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
GREATER LA AC/SC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754
FACILITY NAME:CENTURION RESIDENTIAL CAREFACILITY NUMBER:
198600579
ADMINISTRATOR/
DIRECTOR:
PORTER, FRANCES PORTERFACILITY TYPE:
735
ADDRESS:303 ARDILLA AVE.TELEPHONE:
(626) 369-9185
CITY:LA PUENTESTATE: CAZIP CODE:
91746
CAPACITY: 4CENSUS: 3DATE:
10/28/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
02:50 PM
MET WITH:Katrina Porter, StaffTIME VISIT/
INSPECTION COMPLETED:
04:30 PM
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Licensing Program Analyst (LPA) Cynthia Chan conducted the required annual inspection. LPA arrived unannounced and met with Staff, Katrina Porter. The reason for the visit was explained. The facility is licensed to serve 4 Developmentally Disabled adults ages 18 through 59, of which 2 may be non-ambulatory. There are currently 3 clients residing at the home.

LPA inspected the facility using the Compliance and Regulatory Enforcement (CARE) tools. The following domains were observed:
Infection Control: The facility has the Infection Control Plan and is continuing to follow appropriate hand hygiene. Staff are wearing gloves to assist clients during bathing. Staff are cleaning and disinfecting daily and more often for high touched surfaces.
Physical Plant & Environment Safety: The facility does not have any pool or bodies of water on the premises. There are 4 client bedrooms, 2 bathrooms, living room, family room, staff office, dining room, and kitchen. Each client bedroom has the appropriate furniture, storage space, and lighting. The laundry area is located in the staff office. Extra hygiene supplies were observed. Facility has an operable smoke detector in each room and a carbon monoxide detector. Knives, cleaning solutions, and disinfectants are locked. The hot water temperature was measured between the required range of 105-120 degrees F.
Operational Requirements: The facility is operating within the fire clearance approval. Staff are providing care and supervision to meet the clients' needs and assisting in activities of daily living.
Food Service: There are sufficient food supplies of 2 day perishable and a week of non-perishable items observed. Foods are properly stored in the refrigerator to avoid contamination.

LPA will return another day to complete the remainder of the domains. An exit interview was held and a copy of this report was given to Staff Porter.
SUPERVISORS NAME: Tony Vasallo
LICENSING EVALUATOR NAME: Cynthia D Chan
LICENSING EVALUATOR SIGNATURE: DATE: 10/28/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/28/2024
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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