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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198601928
Report Date: 05/12/2022
Date Signed: 05/12/2022 03:49:52 PM

Document Has Been Signed on 05/12/2022 03:49 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:FLAGSHIP @ YALETONFACILITY NUMBER:
198601928
ADMINISTRATOR:MAGEE, LORINGFACILITY TYPE:
735
ADDRESS:206 N YALETON AVETELEPHONE:
(626) 502-1250
CITY:WEST COVINASTATE: CAZIP CODE:
91790
CAPACITY: 4CENSUS: 4DATE:
05/12/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:50 PM
MET WITH:Loring Magee, AdministratorTIME COMPLETED:
03:55 PM
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Licensing Program Analysts (LPAs) Galarza and Yating Yang conducted an unannounced Required- 1 year visit focusing on COVID-19 Infection Control Practices. LPA met with DSP staff Darvis Jackson and explained the purpose of the visit. There are four (4) level 4i developmentally disabled clients ages 59 and under. Facility is a single story home licensed for 4 non-ambulatory clients located in a residential area consisting of four (4) client bedrooms, 2 bathrooms, kitchen/dining area, living room, covered patio area, and detached garage with laundry area. The last fire drill was completed on 4/25/2022. Administrator certificate expires 1/9/2024.

The following were observed/inspected:
  • COVID-19 Infection Control Practices were observed upon entry and in common areas.
  • Infection control signs, and other signs are posted throughout the facility to promote hand washing, cough/sneeze etiquette, and physical distancing.
  • All client bedrooms are private and designated as COVID-19 isolation room if needed.
  • Hand sanitizer was observed in common areas.
  • Four (4) centrally stored resident medication records were reviewed.
  • Staff responsible for direct care and supervision were observed wearing a mask.
  • Clients were not observed wearing masks in the home due to cognitive impairment.
  • Sufficient supply of perishable for 2 days & non-perishable foods for 7 days were observed.
  • A Emergency Disaster Plan was posted in the front entrance.
  • Sufficient supply of Personal Protective Equipment (PPEs) was observed.

NO deficiencies were cited.
Exit interview was conducted with Administrator Loring Magee. A copy of the report was issued.
SUPERVISORS NAME: Lisa Hicks
LICENSING EVALUATOR NAME: Noemi Galarza
LICENSING EVALUATOR SIGNATURE: DATE: 05/12/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/12/2022
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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