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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198600716
Report Date: 08/25/2023
Date Signed: 08/28/2023 08:55:36 AM

Document Has Been Signed on 08/28/2023 08:55 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: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:
08/25/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
08:15 AM
MET WITH:Administrator Cristina ObstaculoTIME COMPLETED:
11:55 AM
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Licensing Program Analyst (LPA) Jose Villalobos, conducted a required Compliance and Regulatory Enforcement (CARE) Tool. LPA met with Administrator Cristina Obstaculo and the purpose of the visit was discussed.

Structure/Physical Plant: The facility is part of a single story home located in a residential area and contains the following: living room, dining room, kitchen with refrigerator, oven, stove, dishwasher, sink/faucet, locked storage cabinet for medications and sharps, (2) client rooms, (2) bathrooms for clients , (1) Staff room; bathrooms with shower, toilet and washbasin. A back yard with shaded area and seating for client use. There's a laundry area; with washer and dryer. The residence is equipped with Air conditioners around the home. Accommodations: Adequate accommodations observed throughout facility. Hallway and Doorways: Free and clean of obstruction and debris. Client Rooms: All bedrooms are equipped with: overhead lighting, chair, night stand, lamp in addition to overhead lighting, large drawer, and closet space. Bathrooms: All bathrooms have a working toilet, wash basin, shower, grab bars and nonskid mats. Linens & Hygiene Supplies: Required linen/supplies observed. Emergency Phone Numbers, Exit Plan & Menu: Facility has a working phone landline. There is a cordless phone for client use. Fire Extinguishers observed Food Service: All food and adequate utensils such as, dishes, cups, bowls and plates observed. Supply of perishables and non-perishables observed. Smoke Detectors & Fire Extinguishers: Detectors Electrical & connected. All detectors operational. Toxins: Locked/stored for staff use only. Hot Water Temperature: Measured between 105 -110 degrees all around the home. Medications, First-Aid Kit & Book: Medications centrally stored and inaccessible to clients. First aid kit observed. Postings: Wall postings observed. Clients & Staff Files: LPA reviewed (4) of (4) client medication records and files , as well as four (4) Staff Files . Emergency Disaster Plan, Infection Control Plan, and Plan of Operation also observed and reviewed.



Inspection tool completed and no deficiencies are being cited. Exit Interview conducted and a copy of this report was provided
SUPERVISORS NAME: Fernando Fierros
LICENSING EVALUATOR NAME: Jose Villalobos
LICENSING EVALUATOR SIGNATURE: DATE: 08/25/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/25/2023
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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