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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198601069
Report Date: 10/28/2022
Date Signed: 10/09/2023 11:24:38 AM

Document Has Been Signed on 10/09/2023 11:24 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
GREATER LA AC/SC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754
FACILITY NAME:BONNIE'S GUEST HOUSE INC.FACILITY NUMBER:
198601069
ADMINISTRATOR:ALVARADO, DESIREEFACILITY TYPE:
735
ADDRESS:135 NORTH BONNIE AVENUETELEPHONE:
(626) 440-0494
CITY:PASADENASTATE: CAZIP CODE:
91106
CAPACITY: 14CENSUS: 12DATE:
10/28/2022
TYPE OF VISIT:OfficeUNANNOUNCEDTIME BEGAN:
08:54 AM
MET WITH:Desiree Alvarado - Administrator TIME COMPLETED:
09:30 AM
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Licensing Program Analyst(s) (LPA) Mary Flores, Licensing Program Manager (LPM) Tony Vasallo, Regional Manager (RM) Araceli Ramirez, and Pasadena Department of Public Health (PDPH) Community Services Representative(s) (CSR) Misael Rivera, Adrian Griffin and Medical Assistant Quitzia Gonzalez met with Desiree Alvarado - Licensee via a Microsoft Teams Meeting.

The meeting was conducted to discuss facility's compliance with PDPH the following was discuss:
Facilty is to submit accurate information in CMR reporting sheets and when corrections are needed facility is to promptly respond with corrections.
Facility was provided templates for all require documents via email on 10/27/22.
It is a priority to use list to provide information on Congregate living Contact Line List to conduct epilink contact when reporting. Facility is to provide the list for client #1 and client #2 for last reported positive on 8/26/22.
Licensee stated facility does not have a turn around of clients or staff. The list has not change and all staff are vaccinated.
Facility is to communicate and respond to all communication send via email.
PDPH is providing guidance for reporting and testing during this meeting, failure to comply will result in notifying Community Care Licensing.
RM provided notice that moving forward the department will have to provide deficiencies if the facility does not comply with PDPH.
PDPH must received respond testing results after a positive case. Facility is to submit respond testing for the last positive case reported on 8/26/22 or initiate respond testing as of 10/31/22 and submit test results for 2 rounds.
Licensee is to respond email with requested information by November 1st, 2022 and respond testing results by November 4th, 2022.
Facility's are to submit weekly reports to PDPH.
Exit interview was conducted with Desiree Alvarado Licensee and a copy of this report was email for signature.
SUPERVISORS NAME: Stefanie Coronel
LICENSING EVALUATOR NAME: Mary G Flores
LICENSING EVALUATOR SIGNATURE: DATE: 10/28/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/28/2022
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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