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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198600579
Report Date: 11/19/2024
Date Signed: 11/19/2024 03:49:11 PM

Document Has Been Signed on 11/19/2024 03:49 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:
11/19/2024
TYPE OF VISIT:Case Management - Annual ContinuationUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
02:00 PM
MET WITH:Katrina Porter, StaffTIME VISIT/
INSPECTION COMPLETED:
04:05 PM
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Licensing Program Analyst (LPA) Cynthia Chan conducted a subsequent visit to continue the annual inspection. LPA met with Staff, Katrina Porter, and explained the purpose for the visit. Co-Administrator, Angela Porter, arrived shortly after.

LPA started the initial inspection on 10/28/24. The following domains were reviewed today.
Staffing: There is sufficient staffing at the facility. Administrator (Frances Porter) certificate expires on 12/15/24. Staff employed are fingerprint cleared and associated to the facility. There is an awake night staff to provide supervision.
Personnel Records-Training: Staff files are maintained at the facility. LPA reviewed files for 3 Staff. Staff files have current First Aid/CPR certification and the Health Screening and Tuberculosis Screening. Staff are receiving on-going training.
Client Rights-Information: Client rights are posted. There are no clients using postural supports.
Client Records-Incident Reports: Client files are maintained at the facility. LPA reviewed files for 3 Clients. The files contain the Admission Agreement, Physician's Report (including T.B and Ambulatory Status), Weight Record, Consent Forms, Individual Program Plan/IPP, and Client Rights.
Incidental Medical Services: There is no client with a restricted or prohibited health condition.
Disaster Preparedness: The facility has the updated Emergency Disaster Plan (LIC610D) and is conducting different types of drills quarterly.
Emergency Intervention: Staff have ProAct training and use redirection. No restraints are used.

No deficiencies issued today. An exit interview was held and a copy of this report was given to the administrator.
SUPERVISORS NAME: Tony Vasallo
LICENSING EVALUATOR NAME: Cynthia D Chan
LICENSING EVALUATOR SIGNATURE: DATE: 11/19/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/19/2024
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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