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

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198601218
Report Date: 02/09/2023
Date Signed: 02/13/2023 08:55:01 AM

Document Has Been Signed on 02/13/2023 08:55 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
CCLD Regional Office, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754
FACILITY NAME:LOWEMONT HOME INC.FACILITY NUMBER:
198601218
ADMINISTRATOR:AUGUSTUS TORRESFACILITY TYPE:
735
ADDRESS:11445 LOWEMONT STREETTELEPHONE:
(562) 868-3533
CITY:NORWALKSTATE: CAZIP CODE:
90650
CAPACITY: 5CENSUS: 3DATE:
02/09/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
03:30 PM
MET WITH:Augustus TorresTIME COMPLETED:
04:35 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
LPA Angelica Rea conducted an unannounced visit for the purpose of conducting the required annual inspection. On today's visit LPA met with Administrator, Augustus Torres who assisted with the visit.

LPA Rea discussed infection control practices with Mr. Torres, toured the facility inside and out, reviewed food supply, reviewed Staff files, and reviewed resident medications.

Bedrooms have the required furniture including bedframes, dressers, lamps and chairs. Beds have the required linen and the linen is in good condition. Passageways and exits are free of obstruction. The front and backyard are well maintained. The resident bathroom is clean and have the required grab bars in the shower and near the toilets. Showers also have non-skid materials. The hot water temperature measured at 129.1 degrees F in the kitchen, and 128.7 degrees F in the bathroom. The facility temperature at the time the visit was comfortable. There is sufficient lighting throughout the facility. There are smoke detectors & carbon monoxide detector were tested and operational. LPA observed a sufficient supply of PPE. Infection control signs were observed throughout the facility.

Per California Code of Regulations, Title 22, and California Health and Safety Code, there were deficiencies observed during the visit. Deficiencies on 809-D. Exit interview conducted, copy of report and appeal rights provided.
SUPERVISORS NAME: Lisa Hicks
LICENSING EVALUATOR NAME: Angelica Rea
LICENSING EVALUATOR SIGNATURE: DATE: 02/09/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/09/2023
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
Document Has Been Signed on 02/13/2023 08:55 AM - It Cannot Be Edited


Created By: Angelica Rea On 02/09/2023 at 04:09 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: LOWEMONT HOME INC.
FACILITY NUMBER: 198601218

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/09/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
80088(e)(1)


This requirement is not met as evidenced by: LPA Rea observed that water temperature measured 128.7 degrees F in bathroom sink, and 129.1 degrees F in kitchen sink.
Deficient Practice Statement
1
2
3
4
Based on observations, the licensee did not comply with the section cited above in 2 out of 2 sinks, which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 02/13/2023
Plan of Correction
1
2
3
4
Licensee will ensure that water temperature measures between 105 degrees F and 120 degrees F as required. Licensee will send a water log for 3 days indicating that water measures in the required range by POC due date.
Section Cited
Deficient Practice Statement
1
2
3
4
POC Due Date:
Plan of Correction
1
2
3
4
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:Lisa Hicks
LICENSING EVALUATOR NAME:Angelica Rea
LICENSING EVALUATOR SIGNATURE:
DATE: 02/09/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/09/2023


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