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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198601744
Report Date: 04/06/2022
Date Signed: 04/06/2022 04:36:56 PM

Document Has Been Signed on 04/06/2022 04:36 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:
04/06/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
02:50 PM
MET WITH:Alex Stott, AdministratorTIME COMPLETED:
04:45 PM
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Licensing Program Analyst (LPA) Cynthia Chan conducted an annual inspection with the focus of the infection control domain. LPA arrived unannounced and met with the Administrator, Alex Stott. The purpose of the visit was explained. The license is approved for 3 ambulatory and 3 non-ambulatory clients. The facility is vendorized by the Eastern Los Angeles Regional Center as a level 4B home.

LPA Chan toured the facility with the Administrator and observed the following:
* There is a screening area set up outside the front door to take visitors/staff temperature and to fill out covid-19 questionnaire.
* The home has 6 bedrooms (3 upstairs and 3 downstairs) with private bathrooms in each room. Each client has his/her own room. The rooms are equipped with the required furniture. The home also has a living room, office room, open kitchen with dining area, an exercise area, and a separate laundry room.
* Staff were observed wearing face masks and clients as tolerated.
* Staff disinfect and clean at least 3 times a day. Cleaning supplies are stored and locked in the laundry room cabinets.
* Covid-19 signage are posted at the front entrance and throughout the facility including bathrooms.
* There are sufficient supplies of 2 day perishable and a week of non-perishable items. Per the Administrator, they do grocery shopping twice a week.
* The hot water temperature was tested in each client's bathroom and measured between the required range of 105 - 120 degrees Fahrenheit.
* Medications are centrally stored and locked in the office cabinet. LPA reviewed the medications for all 6 clients and are being administered as prescribed by the physician.
* No client or staff files were reviewed during the visit today.
* Facility is still following Community Care Licensing COVID-19 guidance and their mitigation plan.
There are no deficiencies observed. An exit interview was conducted and a copy of this report and appeal rights were provided.
SUPERVISORS NAME: Lisa Hicks
LICENSING EVALUATOR NAME: Cynthia D Chan
LICENSING EVALUATOR SIGNATURE: DATE: 04/06/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/06/2022
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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