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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198601655
Report Date: 05/23/2023
Date Signed: 05/23/2023 02:02:46 PM

Document Has Been Signed on 05/23/2023 02:02 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:WYLAND HOUSEFACILITY NUMBER:
198601655
ADMINISTRATOR:GEORGE LOPEZFACILITY TYPE:
735
ADDRESS:214 E. WYLAND WAYTELEPHONE:
(626) 443-1313
CITY:MONROVIASTATE: CAZIP CODE:
91016
CAPACITY: 4CENSUS: 4DATE:
05/23/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:15 AM
MET WITH:Administrator / Genny Guadalquivir
Health and Services Coordinator / Elsa Montes		TIME COMPLETED:
02:05 PM
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Licensing Program Analyst (LPA) Ashley Calderon conducted an unannounced site visit for the Required - 1 Year inspection. Upon arriving at the facility, LPA met with Administrator Genny Guadalquivir and Health and Services Coordinator Elsa Montes who assisted with the visit. The facility is licensed to serve four (4) Developmentally Disabled Clients ages 18 - 59 years. The facility is approved for Three (3) Ambulatory and One (1) Non-Ambulatory Clients. Currently, there are four (4) clients in placement, (1) client present during time of visit. During today's visit, LPA used the CARE Tool to complete the annual inspection.

LPA along side with Genny conducted a physical plant tour. The facility is located in a residential area. A tour of the single-story facility includes: Three (3) client bedrooms, two (2) bathrooms, recreation room, living room, kitchen, dining area, and indoor/outdoor activity areas.

Bathrooms are clean and operational with grab bars and non skid mats in place. Client bedrooms were checked adequate furniture in place. The hot water temperature was tested throughout the facility and tested at 110.5, within Title 22 regulation. The kitchen was observed for the ability to prepare and serve food. LPA observed an appropriate food supply of two (2) days of perishables and one week (7 days) of non-perishables. Toxins and sharps are in a secured cabinet locked and inaccessible to clients. The facility has central air and heating accommodations, facility temperature measured at 72 Degree F.

Smoke detectors and carbon monoxide are combined, detectors are operable and in compliance. The fire extinguisher was observed in the kitchen area and was fully charged. The first-aid kit is fully stocked w/First-aid Manual. The front yard/ backyard is well landscaped, shaded area provided. Hallways and passage ways are free of debris/hazards and obstructions. No evidence of bodies of water (pool) or security bars nor weapons on the premises. The washer and dryer located outside.

Continuation on LIC 809-C...
SUPERVISORS NAME: Fernando Fierros
LICENSING EVALUATOR NAME: Ashley Calderon
LICENSING EVALUATOR SIGNATURE: DATE: 05/23/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/23/2023
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: WYLAND HOUSE
FACILITY NUMBER: 198601655
VISIT DATE: 05/23/2023
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There is a detached garage with additional storage of food supply. The garage door is kept locked and inaccessible to the clients at all times.

LPA reviewed (4) client files and (6) staff files, all cleared and all required documentation's were filed. LPA interviewed (2) staff and attempt to interview (1) client. LPA Calderon alongside with Elsa reviewed (4) clients medications. Medications are kept locked and inaccessible to other clients.

During the time of visit, per Title 22 regulation, there were no deficiencies observed during the time of visit. An exit interview was conducted and a copy of this report was provided to Health and Services Coordinator Elsa Montes

SUPERVISORS NAME: Fernando Fierros
LICENSING EVALUATOR NAME: Ashley Calderon
LICENSING EVALUATOR SIGNATURE:

DATE: 05/23/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/23/2023
LIC809 (FAS) - (06/04)
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