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

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198601122
Report Date: 06/22/2023
Date Signed: 06/22/2023 05:28:45 PM

Document Has Been Signed on 06/22/2023 05:28 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:INSPIRATION HOMES IIFACILITY NUMBER:
198601122
ADMINISTRATOR:MARSHA HAYWOODFACILITY TYPE:
735
ADDRESS:6745 NORTH GOLDEN WEST AVE.TELEPHONE:
(626) 445-7959
CITY:ARCADIASTATE: CAZIP CODE:
91007
CAPACITY: 4CENSUS: 3DATE:
06/22/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:15 PM
MET WITH:Marsha Haywood, administratorTIME COMPLETED:
05:00 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 Analyst (LPA) Tao conducted an unannounced annual inspection. LPA met with Licensee/Administrator. The facility is licensed to serve four (4) Developmentally Disabled clients, Ambulatory only, from ages 18-59. All clients received case management services from East LA Regional Center. The annual fees are current. LPA discussed the purpose of today's visit with administrator.

Today's visit consisted of: CARE tool was used; staff/ clients were interviewed; staff/clients files were reviewed; a tour of the facility was conducted; food supply was reviewed; and medications were reviewed.

LPA toured the facility inside and outside. This is a single-story house consisted of three (3) client bedrooms, two (2) bathrooms, laundry room, living room, kitchen, dining area, activity room, and indoor/outdoor activity areas. Backyard, front yard and hallway area are free of obstruction. Backyard has shaded area and free of debris/ hazard. The kitchen is clean. Facility has maintained the required two (2) days perishable and seven (7) days non- perishable. All burners and stove tops are in working condition. Client bedrooms were checked and closet/drawer space to accommodate each client were available. Lamps/lights for each room were available to ensure the safety and comfort of all persons in the facility. Adequate linen and personal hygiene supply were observed. Bathrooms were clean and in working condition. Common areas were toured and in compliance.

Smoke detectors and carbon monoxide detectors were tested and were operational. Fire drill was conducted on 3/14/23. Fire extinguisher was fully charged and the last service was on 08/05/22. Comfortable temperature of 73 degree Fahrenheit for clients was maintained. Hot water temperature measured at 116.5 degrees Fahrenheit.

(-Continued in LIC 809 C-)
SUPERVISORS NAME: Fernando Fierros
LICENSING EVALUATOR NAME: Bonnie Tao
LICENSING EVALUATOR SIGNATURE: DATE: 06/22/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/22/2023
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: INSPIRATION HOMES II
FACILITY NUMBER: 198601122
VISIT DATE: 06/22/2023
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
Pesticides/poisons were locked and inaccessible to clients. Sharp tools and knives were locked and inaccessible to clients. Hazardous items were locked and inaccessible to clients.

Medications were centrally stored, locked in a cabinet located in the dining area. Medications were properly logged and current.

Administrator certificate is current and the expiration date is 06/11/25.



No deficiencies were cited per California Code of Regulations, Title 22, Division 6.

An exit interview was conducted. This report is discussed and provided to facility Administrator, whose signature on this form confirm receipt of these documents.

SUPERVISORS NAME: Fernando Fierros
LICENSING EVALUATOR NAME: Bonnie Tao
LICENSING EVALUATOR SIGNATURE:

DATE: 06/22/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/22/2023
LIC809 (FAS) - (06/04)
Page: 2 of 2