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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198601520
Report Date: 03/05/2024
Date Signed: 03/05/2024 12:30:39 PM

Document Has Been Signed on 03/05/2024 12:30 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:CECILIA'S GUEST HOMEFACILITY NUMBER:
198601520
ADMINISTRATOR:CECILIA NUNEZFACILITY TYPE:
735
ADDRESS:8037 PARK LANETELEPHONE:
(323) 771-1667
CITY:BELL GARDENSSTATE: CAZIP CODE:
90201
CAPACITY: 4CENSUS: 4DATE:
03/05/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Enrique NunezTIME COMPLETED:
12:45 PM
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Licensing Program Analyst (LPA) Glenn Trueman made a visit to the facility and was greeted by Assistant Administrator Enrique Nunez and explained the reason for the visit.
Shortly thereafter Administrator Cecelia Nunez arrived.
The purpose of the visit is to conduct the required 2024 annual inspection.
Annual Inspection includes the following Domains:
Infection Control, Physical Plant and Environmental Safety, Operational Requirements, Staffing, Personnel Records- Training, Client Rights Information, Client rights- Incident Reports, Food Service, Health Related services, Incidental Medical Services, Disaster Preparedness, and Emergency Intervention.
Tour of the facility was conducted and the following was observed;
There are 4 Client Bedrooms which have the required furniture such as bedframes, dressers, lamps and chairs.
Beds have the required linen and the linen is in good condition.
There are 2 Client bathrooms. The bathrooms are clean and have the required hygiene items. The hot water temperature was within the required 105 - 120 degrees.
The facility temperature at the time the visit was comfortable.
There is sufficient lighting throughout the facility. There are smoke detectors located throughout the facility. There is a carbon monoxide detector. The kitchen was inspected. There is sufficient perishable and non-perishable food. The food was also stored properly. Kitchen appliances are clean and are operating properly. The front and backyard are well maintained. There is no pool or other large bodies of water.
Planned activities are conducted daily and there is sufficient space inside and outside of facility.
5 Staff were interviewed and 4 Client's were not interviewed. All client's were at the Day Program.

No deficiencies.

Exit interview conducted.
SUPERVISORS NAME: Wei Siew Ho
LICENSING EVALUATOR NAME: Glenn Trueman
LICENSING EVALUATOR SIGNATURE: DATE: 03/05/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/05/2024
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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