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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198600721
Report Date: 07/09/2024
Date Signed: 07/09/2024 01:28:05 PM

Document Has Been Signed on 07/09/2024 01:28 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/
DIRECTOR:		ZONEL E PASCASIOFACILITY TYPE:
735
ADDRESS:4440 STEWART AVENUETELEPHONE:
(626) 480-8110
CITY:BALDWIN PARKSTATE: CAZIP CODE:
91706
CAPACITY: 5CENSUS: 5DATE:
07/09/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:10 AM
MET WITH:Melanie FajardoTIME VISIT/
INSPECTION COMPLETED:
01:30 PM
NARRATIVE
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Licensing Program Analyst (LPA) Nune Margaryan conducted an unannounced annual visit utilizing the CARE tools. LPA met with Melanie Fajardo. Administrator Tony Pascasio arrived shortly after. LPA explained the reason for the visit.
The physical plant was inspected along with medications, food supply, and clients and staff records. The facility is licensed to serve developmentally disable clients between the ages 18 to 59 of which (2) may be non-ambulatory and (3) may be ambulatory. There are currently 5 clients residing at the home and receive services from San Gabriel / Pomona regional Center.

LPA and Administrator toured the home and inspected (4) client bedrooms, (2) bathrooms, kitchen, dining room, living room, office and attached garage. Laundry area observed in the garage.

LPA observed the facility was undergoing the construction in the backyard which the administrator did not notify Licensing of the proposed changes. There are no pools or large bodies of water. There is a shaded seating area 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 110.0 F in bathroom #1 and 110.2 F in bathroom #2 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. Extra linens, blankets, towels, and personal hygiene supplies were observed. Smoke detectors were observed throughout the facility. There is a carbon monoxide detector in the living room of the home and was tested and operable during the visit. There is a fireplace located in the living room area which covered by a screen. There is a fire extinguisher located in the kitchen and it is fully charged. Kitchen appliances are clean and were operating at the time of the visit.

Continue 809C.

SUPERVISORS NAME: Wei Siew Ho
LICENSING EVALUATOR NAME: Nune Margaryan
LICENSING EVALUATOR SIGNATURE: DATE: 07/09/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/09/2024
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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Document Has Been Signed on 07/09/2024 01:28 PM - It Cannot Be Edited


Created By: Nune Margaryan On 07/09/2024 at 12:01 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754

FACILITY NAME: TOUCHING LIVES RESIDENTIAL I
FACILITY NUMBER: 198600721

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/09/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
80087(g)(1)
Building and Grounds
(g) Disinfectants, cleaning solutions, poisons, firearms and other items that could pose a danger if readily available to clients shall be stored where inaccessible to clients. (1) Storage areas for poisons, and firearms and other dangerous weapons shall be locked.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, the licensee did not comply with the section cited above. Knifes were observed unlocked in a kitchen drawer and are accessible to clients, which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 07/10/2024
Plan of Correction
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Kitchen drawer locked immediately. Licensee shall ensure that all knifes / sharp objects will be locked and not accessible to clients. Administrator will provide training to staff regarding section 80087 and maintaining all knifes / sharp objects inaccessible to the clients by POC due date 07/10//24.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Wei Siew Ho
LICENSING EVALUATOR NAME:Nune Margaryan
LICENSING EVALUATOR SIGNATURE:
DATE: 07/09/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/09/2024


LIC809 (FAS) - (06/04)
Page: 2 of 5
Document Has Been Signed on 07/09/2024 01:28 PM - It Cannot Be Edited


Created By: Nune Margaryan On 07/09/2024 at 12:01 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754

FACILITY NAME: TOUCHING LIVES RESIDENTIAL I
FACILITY NUMBER: 198600721

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/09/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
85076(d)(1)
Food Service
(1) Supplies of staple nonperishable foods for a minimum of one week and fresh perishable foods for a minimum of two days shall be maintained on the premises.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, the licensee did not comply with the section cited above. There is not enough non-perishable foods for 7 days were observed, which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 07/09/2024
Plan of Correction
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Grocery shopping was done at the time of visit. The administrator will ensure nonperishable a minimum of one week shall be maintained on the premises.
Cleared at the time of visit.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Wei Siew Ho
LICENSING EVALUATOR NAME:Nune Margaryan
LICENSING EVALUATOR SIGNATURE:
DATE: 07/09/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/09/2024


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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
CCLD Regional Office, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754
FACILITY NAME: TOUCHING LIVES RESIDENTIAL I
FACILITY NUMBER: 198600721
VISIT DATE: 07/09/2024
NARRATIVE
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Sharps were observed unlocked in a kitchen drawer and are accessible to clients. There are not enough non-perishable foods for 7 days were observed. Cleaning supplies and toxins are locked in a cabinet located in the garage and are inaccessible to clients. First Aid kit was fully stocked with current manual. Centrally stored medications are stored in a locked cabinet in the hallway. LPA reviewed clients and staff files. LPA confirmed staff working have fingerprint clearances. LPA reviewed clients medications. Medications are documented properly and given as prescribed. Fire drill conducted on 06/15/2024.


Observed deficiency is documented on 809D.

Exit interview conducted with Administrator and the copy of the report and appeal rights are provided.

SUPERVISORS NAME: Wei Siew Ho
LICENSING EVALUATOR NAME: Nune Margaryan
LICENSING EVALUATOR SIGNATURE:

DATE: 07/09/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/09/2024
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 07/09/2024 01:28 PM - It Cannot Be Edited


Created By: Nune Margaryan On 07/09/2024 at 12:43 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754

FACILITY NAME: TOUCHING LIVES RESIDENTIAL I
FACILITY NUMBER: 198600721

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/09/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
80086(a)


This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, the licensee did not comply with the section cited above. At the time of annual inspection LPA observed the facility was undergoing the construction in the backyard which the administrator did not notify Licensing of the proposed changes.

which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 07/16/2024
Plan of Correction
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 Licensee will ensure prior to construction or alternations, shall notify Licensing agency of the proposed changes.
Licensee/ Administrator to send letter to Licensing that they have read and understand section 80068(a) of Title 22 and inform Licensing of construction currently being conducted. The administrator will send the updated facility sketch to LPA.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Wei Siew Ho
LICENSING EVALUATOR NAME:Nune Margaryan
LICENSING EVALUATOR SIGNATURE:
DATE: 07/09/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/09/2024


LIC809 (FAS) - (06/04)
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