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

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198601744
Report Date: 08/25/2021
Date Signed: 08/25/2021 12:14:01 PM

Document Has Been Signed on 08/25/2021 12:14 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:JOHN AND MARY DUCE CENTREFACILITY NUMBER:
198601744
ADMINISTRATOR:BLANCA MACIASFACILITY TYPE:
735
ADDRESS:523 N. CHANDLER AVETELEPHONE:
(626) 289-8766
CITY:MONTEREY PARKSTATE: CAZIP CODE:
91754
CAPACITY: 6CENSUS: 6DATE:
08/25/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:32 AM
MET WITH:Alex Stott, AdministratorTIME COMPLETED:
12:15 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. The facility is licensed to serve three (3) ambulatory and three (3) non-ambulatory Developmentally Disabled Ambulatory clients, (age 18-59). Client census is six (6). LPA was allowed entry by administrator. East Los Angeles Regional Center provides case management service to client residing in this home. The annual fee is paid. LPA discussed the purpose of today's visit.

During the visit, the following domain of the new inspection tool was used: infection control domain; a tour of the facility conducted; food supply was reviewed; and medications were reviewed.

LPA met with Alex Stott, Administrator who assisted with the visit. LPA toured the facility inside and outside. The home is located in a residential neighborhood within the city of Monterey Park and is a two-story building which consists of six (6) client bedrooms, seven (7) bathrooms, activity area, dining area, kitchen, and administrator office. Administrator certificate is current and expiration date is 10/11/21.

Three (3) bedrooms downstairs were for non-ambulatory clients, three (3) bedrooms upstairs were for ambulatory clients. All required furniture was observed. Clients' bedrooms were spacious, easily accommodate the clients' furnishings, had appropriate linens and in good condition. Client bedrooms had beds, dressers, chairs and closet space available. Bathrooms are clean and operational.

Fire extinguishers and smoke detectors are current and in compliance with fire safety. Fire detectors are hard wired. Fire extinguishers’ last service was 8/3/2021 and were fully charged. Fire drill was conducted on April 21, 2021. The first aid kit was fully stocked with a manual. Hot water temperature measured at 110.5 degrees Fahrenheit. The required two (2) days perishable and seven (7) days non- perishable were observed. All burners and stove tops were in working condition. There is a patio area with a shaded area and plenty of seating for clients. (-continued in LIC 809 C-)
SUPERVISORS NAME: Fernando Fierros
LICENSING EVALUATOR NAME: Bonnie Tao
LICENSING EVALUATOR SIGNATURE: DATE: 08/25/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/25/2021
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: JOHN AND MARY DUCE CENTRE
FACILITY NUMBER: 198601744
VISIT DATE: 08/25/2021
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 not stored in food areas, kitchen, or where kitchen equipment/utensils were stored.

Medications were centrally stored, locked in a cabinet located in administrator office. Medications were properly logged and current. Hazardous items were locked and inaccessible to clients.

No deficiencies 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: 08/25/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/25/2021
LIC809 (FAS) - (06/04)
Page: 2 of 2