<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198600721
Report Date: 08/02/2022
Date Signed: 08/02/2022 03:53:19 PM

Document Has Been Signed on 08/02/2022 03:53 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:TOUCHING LIVES RESIDENTIAL IFACILITY NUMBER:
198600721
ADMINISTRATOR:GLORIE PASCASIOFACILITY TYPE:
735
ADDRESS:4440 STEWART AVENUETELEPHONE:
(626) 480-8110
CITY:BALDWIN PARKSTATE: CAZIP CODE:
91706
CAPACITY: 5CENSUS: 5DATE:
08/02/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:30 PM
MET WITH:Lead Staff Charito LardizabealTIME COMPLETED:
03:50 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
Licensing Program Analysts (LPA) Nune Margaryan conducted an annual required visit. LPA met with lead staff Charito Lardizabeal and explained the reason for the visit. LPA used the infection control tool to evaluate the facility. The physical plant was inspected along with COVID-19 procedures, medications, food supply, and resident and staff records. The facility has an approved mitigation plan on file. The facility is licensed to serve developmentally disable clients between the ages 18 to 59. There are currently 5 clients residing at the home and receive services from San Gabriel / Pomona Regional Center.
LPA toured the home and inspected (4) client bedrooms, (2) bathrooms, kitchen, dining room, living room, office, patio and attached garage. Laundry area is observed in the garage. The front and backyard are well maintained and there are no pools or large bodies of water. There is a shaded seating area / patio for the clients located in the backyard. Passageways and exits are free of obstruction. The water temperature was tested in both bathrooms and measured at 108.7 F - 112.6 F which is within the required 105 - 120 degrees. Client bedrooms have the required furniture such as bed frames, dressers, lamps and chairs. Bedrooms also have sufficient closet space. Clients beds have the required linen and the linen is in good condition. Smoke detectors were observed throughout the facility and were tested and operable during the visit. There is a carbon monoxide detector in the living room of the home. There is a fire extinguisher located in the dining room and it is fully charged. Kitchen appliances are clean and were operating at the time of the visit. LPA observed an appropriate food supply of nonperishable foods for a minimum of one week and perishable foods for a minimum of two days. Sharps are locked in a kitchen drawer and are inaccessible to clients. Cleaning supplies and toxins are locked in a cabinet located in the garage and are inaccessible to clients.

Continue 809C
SUPERVISORS NAME: Wei Siew Ho
LICENSING EVALUATOR NAME: Nune Margaryan
LICENSING EVALUATOR SIGNATURE: DATE: 08/02/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/02/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 2
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754
FACILITY NAME: TOUCHING LIVES RESIDENTIAL I
FACILITY NUMBER: 198600721
VISIT DATE: 08/02/2022
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
LPA observed the centrally stored medication cabinet to be locked in the hallway cabinet and inaccessible to clients. The first aid kit was observed and found to be in compliance with the Title 22 Regulations.

LPA reviewed client files to confirm emergency contacts have been updated. LPA confirmed staff working have fingerprint clearances. LPA reviewed clients medications. Medications are documented properly and given as prescribed.



No deficiency was observed during today's visit. Exit interview was conducted and a copy of report was provided.
SUPERVISORS NAME: Wei Siew Ho
LICENSING EVALUATOR NAME: Nune Margaryan
LICENSING EVALUATOR SIGNATURE:

DATE: 08/02/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/02/2022
LIC809 (FAS) - (06/04)
Page: 2 of 2