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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198600721
Report Date: 07/10/2023
Date Signed: 07/10/2023 04:40:38 PM

Document Has Been Signed on 07/10/2023 04:40 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:TOUCHING LIVES RESIDENTIAL IFACILITY NUMBER:
198600721
ADMINISTRATOR:ZONEL E PASCASIOFACILITY TYPE:
735
ADDRESS:4440 STEWART AVENUETELEPHONE:
(626) 480-8110
CITY:BALDWIN PARKSTATE: CAZIP CODE:
91706
CAPACITY: 5CENSUS: 5DATE:
07/10/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:50 PM
MET WITH:Mateo Amor, DSPTIME COMPLETED:
04:50 PM
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Licensing Program Analyst (LPA) Cynthia Chan conducted the required annual inspection. LPA arrived unannounced and met with Staff, Mateo Amor. House Manager, David Daquioag, arrived shortly thereafter to assist with the visit. The facility is licensed to serve (5) developmentally disabled clients ages 18 - 59, of which 2 may be non-ambulatory.

LPA utilized the Compliance and Regulatory Enforcement (CARE) tools for the visit today and observed the following:
Infection Control: Facility is continuing to clean and disinfect on every shift and more often if needed. They are performing proper hand hygiene and using PPE supplies when necessary. The facility has an Infection Control Plan in place.
Physical Plant & Environment Safety: There is no swimming pool on the premises or items obstructing the walkways. There are 4 client bedrooms, 2 bathrooms, living room, dining room, kitchen, and attached garage. The outdoor area consists of a shaded area for clients to use. The fireplace is not in use and is secured by a fence. Smoke alarms and carbon monoxide detector are operable. Fire extinguisher was last inspected on 2/14/23. Knives, cleaning solutions, and disinfectants are locked and inaccessible to client. The hot water temperature was measured and is within the required range of 105 – 120 degrees F.
Operational Requirements: The fire clearance is approved for (5) clients and facility is operating within their requirements. There are currently 3 ambulatory and 2 non-ambulatory clients at the home, receiving services through the San Gabriel/Pomona Regional Center.
Staffing: There is sufficient staffing at the facility. Staff employed are over the ages of 18 and are fingerprint cleared and associated to the facility.
Personnel Records-Training: Staff files are maintained at the facility. LPA reviewed 3 staff files and they have the required documents such as current First Aid/CPR certification and Health Screening forms with Tuberculosis test results.
SUPERVISORS NAME: Tony Vasallo
LICENSING EVALUATOR NAME: Cynthia D Chan
LICENSING EVALUATOR SIGNATURE: DATE: 07/10/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/10/2023
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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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: TOUCHING LIVES RESIDENTIAL I
FACILITY NUMBER: 198600721
VISIT DATE: 07/10/2023
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Client Rights-Information: There are no clients using postural supports. Clients have internet access and are provided with personal rights.
Client Records-Incident Reports: Client files are maintained at the facility and LPA reviewed all 5 files. They have the required documents such Admission Agreement, Physician's Report with TB test results, Weight Record, Consent forms, Client Rights, and Individual Program Plans.
Food Service: There are sufficient food supplies of 2-day perishable and a week of non-perishable items. The foods are properly stored in the refrigerator. There are no clients on special diets. Pesticides and cleaning supplies are kept away from the food preparation areas. Plates, cups and utensils are kept cleaned.
Health Related Services: The medications are centrally stored. LPA reviewed medication for all 5 Clients. Medications are administered as prescribed by the physician and documented correctly on the MAR log.
Incidental Medical Services: There are no clients with restricted health conditions.
Disaster Preparedness: The facility has the updated Emergency Disaster Plan which includes items such as emergency contact information, shut off valves, and evacuation procedures.

There are no deficiencies issued today but a Technical Assistance was given. An exit interview was held and a copy of this report was given to the David Daquioag.
SUPERVISORS NAME: Tony Vasallo
LICENSING EVALUATOR NAME: Cynthia D Chan
LICENSING EVALUATOR SIGNATURE:

DATE: 07/10/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/10/2023
LIC809 (FAS) - (06/04)
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