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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198600611
Report Date: 01/25/2023
Date Signed: 01/25/2023 11:45:18 AM

Document Has Been Signed on 01/25/2023 11:45 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 CNTR DR. ST 500
MONTEREY PARK, CA 91754
FACILITY NAME:ABRAJANO GROUP HOMEFACILITY NUMBER:
198600611
ADMINISTRATOR:ABRAJANO, JOSEPHFACILITY TYPE:
735
ADDRESS:5953 E. GALLANT ST.TELEPHONE:
(562) 928-1927
CITY:BELL GARDENSSTATE: CAZIP CODE:
90201
CAPACITY: 12CENSUS: 5DATE:
01/25/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:45 AM
MET WITH:Connie VillanuevaTIME COMPLETED:
12:00 PM
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Licensing Program Analyst (LPA) Glenn Trueman made an unannounced visit and was greeted by Caregiver Connie Villanueva and explained the reason for the visit.
The purpose of the visit is to complete the required inspection.
LPA Trueman toured the facility along with Caregiver Connie Villanueva today 01/25/2023 at 09:55 AM and the following was observed:
Facility contains 4 Bedrooms and 4 Bathrooms, dining room, living room, TV room, and backyard area.
Required Annual inspection included Infection Control Domain and check of the food supply, medications and criminal clearance check.
LPA observed sufficient supply of 2 day perishables and 7 day non perishables.
All staff were cleared and associated. Medication for clients were verified as a 30 day supply on hand.
Medication for all 5 clients showed 01/25 dosage still in the bubble pack and not administered. Caregiver confirmed 1 day of morning medication was missed and not administered.
Visitation signage was posted along with signage for hand washing and proper sanitizing.
Temperature checks are conducted 2x a day 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.
Bathrooms have proper signage for hand washing. There are multiple stations for hand sanitizing.
Social distancing is implemented. Meal times are sanitized after each meal.
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. Deficiency cited on the 809 D. Advisory notices issued. Exit interview conducted.
SUPERVISORS NAME: Wei Siew Ho
LICENSING EVALUATOR NAME: Glenn Trueman
LICENSING EVALUATOR SIGNATURE: DATE: 01/25/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/25/2023
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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