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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198601603
Report Date: 02/17/2023
Date Signed: 02/17/2023 01:34:31 PM

Document Has Been Signed on 02/17/2023 01:34 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:ELWYN NC - LOS LOTESFACILITY NUMBER:
198601603
ADMINISTRATOR:LAURIE HERNANDEZFACILITY TYPE:
734
ADDRESS:15041 LOS LOTES AVETELEPHONE:
(562) 360-1225
CITY:WHITTIERSTATE: CAZIP CODE:
90605
CAPACITY: 5CENSUS: 5DATE:
02/17/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:15 AM
MET WITH:Rose Rivas, House Manager TIME COMPLETED:
01:50 PM
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Licensing Program Analyst (LPA) Angelica Rea conducted an annual/required visit. LPA met with Registered Nurse (RN), House Manager Rose Rivas and explained the reason for the visit.

LPA Rea discussed infection control practices with Ms. Rivas, toured the facility inside and out, reviewed food supply, and reviewed resident medications. Passageways are clear and free of obstructions. The front and backyard are well maintained. The backyard has patio furniture and a shaded area. There are no pools or large bodies of water. Cleaning supplies and toxicants are inaccessible to clients. Facility maintains a comfortable temperature. There is sufficient lighting throughout the facility including bedrooms and common areas. The client bedrooms have the required furniture such as bed frames, dresser drawers, lamps and lift systems. There is sufficient closet space for each client. The client bathroom was observed to be clean during the visit and had the required equipment to meet the clients needs. The hot water temperature was tested and was 120 degrees, which is within the required range of 105-120 degrees. The back-up power system is located in the garage. The smoke detectors/carbon monoxide detectors were tested during the visit and were operating properly. 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 no deficiencies observed during the visit. Exit interview conducted, and a copy of report was provided to Ms. Rivas.
SUPERVISORS NAME: Lisa Hicks
LICENSING EVALUATOR NAME: Angelica Rea
LICENSING EVALUATOR SIGNATURE: DATE: 02/17/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/17/2023
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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