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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198600654
Report Date: 02/08/2024
Date Signed: 02/08/2024 03:54:36 PM

Document Has Been Signed on 02/08/2024 03:54 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:CONTINENTAL GUEST HOMEFACILITY NUMBER:
198600654
ADMINISTRATOR:RUBERTO BALUYOTFACILITY TYPE:
735
ADDRESS:15482 PASTRANA DRIVETELEPHONE:
(714) 522-3013
CITY:LA MIRADASTATE: CAZIP CODE:
90638
CAPACITY: 4CENSUS: 4DATE:
02/08/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:35 AM
MET WITH:Gina Baluyot, Co-AdministratorTIME COMPLETED:
04:00 PM
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Licensing Program Analyst (LPA) Cynthia Chan conducted the unannounced annual inspection on 2/8/24. LPA met with Co-Administrator, Gina Baluyot, and explained the purpose of the visit. The facility is licensed to serve 4 Developmentally disabled adults, ages 18 through 59, of which 2 may be non-ambulatory. There are currently 4 clients residing at the home and receive services from the Eastern Los Angeles Regional Center.

LPA utilized the Compliance and Regulatory Enforcement (CARE) tool during the inspection today. The following were observed:
Infection Control: The staff perform hand hygiene and wear gloves when necessary to assist clients. Staff are continuing to clean and disinfect each day.
Physical Plant & Environment Safety: The facility does not have any pool or bodies of water on the premises. There are 3 client bedrooms, 1 Staff room, 2 bathrooms, living room, dining room, kitchen, administrative area, and attached garage. Each client bedroom has the required furniture and bedding. There are extra hygiene supplies and linen available. There are no items obstructing the hallways or walkways. Facility has interconnected smoke detector in each room and a carbon monoxide detector in the living room. Knives and cleaning solutions are locked in the kitchen area. The hot water temperature in the bathrooms was measured between the required range of 105-120 degrees F.
Operational Requirements: There are currently 4 clients residing at the home. Proper care and supervision is being provided to the clients.
Staffing: There is sufficient staffing at the facility. Per the administrator, there is an awake staff for the overnight shift monitoring the clients.
Personnel Records-Training: Staff files are maintained at the facility. Administrator (Ruperto Baluyot) has submitted documents to renew the administrator's certificate. LPA verified they were received on 8/17/23 and is currently pending review. Staff have current CPR/first aid training and sufficient on-going training that meets the annual requirement. LPA reviewed (5) personnel files. Staff #5 did not have fingerprint clearance nor associated to the facility.
SUPERVISORS NAME: Tony Vasallo
LICENSING EVALUATOR NAME: Cynthia D Chan
LICENSING EVALUATOR SIGNATURE: DATE: 02/08/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/08/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

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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
GREATER LA AC/SC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754
FACILITY NAME: CONTINENTAL GUEST HOME
FACILITY NUMBER: 198600654
VISIT DATE: 02/08/2024
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Clients Rights - Information: Client rights are posted at the facility. Facility provides internet for client to use.
Client Records-Incident Reports: Client files are maintained at the facility. LPA reviewed (4) client files and they have the required documentation including current Individual Program Plan. There are no clients with a restricted health condition.
Food Service: There are sufficient food supplies of 2-day perishable and a week of non-perishable items. Client are provided with at least 3 meals per day.
Health-Related Services: Medications are centrally stored and locked in a hallway cabinet. The facility documents medications given daily. LPA reviewed medications for 4 clients and they are being administered as prescribed by the physician.
Incidental Medical & Dental: There are no clients receiving home health services or has a health condition that needs to be monitored more carefully.
Disaster Preparedness: The facility has an Emergency Disaster Plan with contact numbers and at least 2 relocation sites. Staff are provided training on the emergency procedures annually and know where the utility shutoff valves are located. LPA provided a technical advisory for the emergency disaster drills that shall be conducted at least quarterly.
Emergency Intervention: Staff receive CPI training but do not utilize any manual restraints at the facility. Clients are verbally redirected.

A deficiency and civil penalties were issued today. An exit interview was held with Gina Baluyot. A copy of this report along with appeal rights were given.
SUPERVISORS NAME: Tony Vasallo
LICENSING EVALUATOR NAME: Cynthia D Chan
LICENSING EVALUATOR SIGNATURE:

DATE: 02/08/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/08/2024
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Document Has Been Signed on 02/08/2024 03:54 PM - It Cannot Be Edited


Created By: Cynthia D Chan On 02/08/2024 at 03:29 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754

FACILITY NAME: CONTINENTAL GUEST HOME
FACILITY NUMBER: 198600654

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/08/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
80019(e)
Criminal Record Clearance
(e) All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1522 shall prior to working, residing or volunteering in a licensed facility:

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, the licensee did not comply with the section cited above in that 1 out of 5 staff did not have fingerprint clearance which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 02/09/2024
Plan of Correction
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The licensee shall ensure employees obtain a criminal background clearance prior to being employed at the facility. The licensee shall submit a written statement acknowledging this regulation by 2/9/24 and ensure staff #5 obtains clearance before returning to work.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Tony Vasallo
LICENSING EVALUATOR NAME:Cynthia D Chan
LICENSING EVALUATOR SIGNATURE:
DATE: 02/08/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/08/2024


LIC809 (FAS) - (06/04)
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