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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198600716
Report Date: 05/20/2022
Date Signed: 05/20/2022 02:55:38 PM

Document Has Been Signed on 05/20/2022 02:55 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
CCLD Regional Office, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754
FACILITY NAME:RIESHEL HOMEFACILITY NUMBER:
198600716
ADMINISTRATOR:OBSTACULO, CRISTINAFACILITY TYPE:
735
ADDRESS:9664 RIESHEL STREETTELEPHONE:
(562) 801-1971
CITY:PICO RIVERASTATE: CAZIP CODE:
90660
CAPACITY: 4CENSUS: 4DATE:
05/20/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:00 PM
MET WITH:Administrator Cristina ObstaculoTIME COMPLETED:
02:00 PM
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Licensing Program Analyst (LPA) Jose Villalobos made and unannounced Annual inspection focused on Infection Control. On today’s visit LPA met with Administrator Cristina Obstaculo and the purpose of the visit was discussed.

As a part of the inspection, LPA used the inspection tool, reviewed (4) client records, (2) staff files, and (4) client medications. Currently the facility has (4) clients which are ambulatory. The facility is vendorized through Eastern Los Angeles Regional Center. Facility is a one story family home with three (3) bedrooms. (2) bedrooms are for 2 clients each and (1) bedroom is for staff. There are (2) full bathrooms, living room, kitchen, central air and heating, dining area, laundry room, a shaded area located in the backyard. a detached car garage inaccessible to clients. Front and back yard is in good condition at time of visit. Washer/Dryer appliances observed. Toxins and sharps locked and inaccessible to clients. Bedrooms #1-#2 are equipped with two twin beds each, a dresser, lamp, chair, overhead lightning. Bathrooms have a working toilet, wash basin, and showers. Beds have the required linen/supplies which include, pillowcase, mattress padding, fitted sheet, blanket and bedspreads. Supply of hygiene supplies stored in each client's bedrooms were observed. Fire alarms are interconnected and operational. Required postings observed. Water temperature within required tittle 22 regulations.

Infection control domain completed and there were no deficiencies. An exit interview was conducted. Copy of this report provided to Administrator Cristina Obstaculo.
SUPERVISORS NAME: Fernando Fierros
LICENSING EVALUATOR NAME: Jose Villalobos
LICENSING EVALUATOR SIGNATURE: DATE: 05/20/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/20/2022
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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