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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198601744
Report Date: 10/28/2024
Date Signed: 10/28/2024 02:51:19 PM

Document Has Been Signed on 10/28/2024 02:51 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
GREATER LA AC/SC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754
FACILITY NAME:JOHN AND MARY DUCE CENTREFACILITY NUMBER:
198601744
ADMINISTRATOR/
DIRECTOR:		GARCIA, NOEYFACILITY TYPE:
735
ADDRESS:523 N. CHANDLER AVETELEPHONE:
(626) 289-8766
CITY:MONTEREY PARKSTATE: CAZIP CODE:
91754
CAPACITY: 6CENSUS: 6DATE:
10/28/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:29 PM
MET WITH:Alex Stott, House ManagerTIME VISIT/
INSPECTION COMPLETED:
02:59 PM
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Licensing Program Analyst (LPA) Alberto Lopez made unannounced visit to follow up on Regional Center Monitoring Review. LPA met with House Manager Alex Stott and discussed purpose of the visit.

LPA took tour of facility inspected the following:

Facility Staff Files:
S1 and S2 CPR certificates were reviewed and are current.
Staff Reporting Requirements: Training competed, LPA observed training sign in log dated 08/2024
Staff IDs were observed.

Facility Resident Files:
C1 and C2 were reviewed and are current.

Physical Environment.
LPA took tour of facility, all rooms and bathrooms.

Forms:
Emergency Plan: Reviewed and acceptable.

Food:
Sufficient for 2 day perishable and 7 day non-perishable.

At the time of visit, LPA did not observe any deficiencies.

Exit interview conducted and copy of report provided.



SUPERVISORS NAME: Lisa Hicks
LICENSING EVALUATOR NAME: Alberto Lopez
LICENSING EVALUATOR SIGNATURE: DATE: 10/28/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/28/2024
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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