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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198600706
Report Date: 04/05/2022
Date Signed: 04/06/2022 10:41:24 AM

Document Has Been Signed on 04/06/2022 10:41 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:CATHERINE'S HOMES, INC. (FLOWER ST)FACILITY NUMBER:
198600706
ADMINISTRATOR:MICHAEL SAN DIEGOFACILITY TYPE:
735
ADDRESS:9130 FLOWER STREETTELEPHONE:
(562) 263-9866
CITY:BELLFLOWERSTATE: CAZIP CODE:
90706
CAPACITY: 5CENSUS: 3DATE:
04/05/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:56 PM
MET WITH:Mellanie Aikman TIME COMPLETED:
02:00 PM
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Licensing Program Analyst (LPA) Christine Wong conducted an unannounced annual required visit. LPA met with administrator Mellanie Aikman and explained the reason for the visit. LPA used the infection control tool to evaluate the facility. LPA observed the facility plant, COVID-19 procedures, observed food supply, and reviewed clients files. Facility has submitted a mitigation plan and was approved on 07/29/2021

The facility is a single story house. The facility included 1st living room, dining area, two live in staff rooms with bathroom, staff office, 2nd living room, kitchen, five clients bedrooms, two clients bathrooms and a detached garage. All five clients bedrooms were toured. Each bedroom has a smoke detector, bed, linen, dresser, light, and sufficient closet space. All two clients bathrooms were toured and they are clean and sanitary. The hot water in two clients bathrooms was measured between 109.9 and 110.3 degrees F which is within the Title 22 regulation. The refrigerator in the kitchen and the kitchen cabinet is sufficient for two days perishable and seven days non-perishable food supply. All the appliances are clean and working properly. The common areas such as living room and dining area are clean and have the required furniture. The back yard and front yard are maintained well. All the exit and passage ways are free of obstruction. All the cleaning supplies are locked under the sink and all the sharp knives and utensils are locked in the kitchen cabinet. The clients medication are centrally stored and locked in the medication cabinet in the staff office. LPA also inspected the smoke detectors and carbon monoxide detectors in the facility are working properly.

Facility is currently following COVID 19 recommendations regarding COVID 19 signs throughout the facility, disinfecting products are available in the common area and facility is disinfected everyday, clients bathrooms have sufficient soap, paper towels, and signs and PPE supplies are stored for 30 days.

No deficiencies were found during this visit. Exit interview was conducted with administrator Mellanie Aikman and a copy of this report was provided.
SUPERVISORS NAME: Christine Yee
LICENSING EVALUATOR NAME: Christine Wong
LICENSING EVALUATOR SIGNATURE: DATE: 04/05/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/05/2022
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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