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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198601940
Report Date: 07/12/2024
Date Signed: 07/15/2024 02:57:57 PM

Document Has Been Signed on 07/15/2024 02:57 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:VILLA FLORAFACILITY NUMBER:
198601940
ADMINISTRATOR/
DIRECTOR:		ROSALINDA BUENVIAJEFACILITY TYPE:
735
ADDRESS:10932 CARMENITA RD.TELEPHONE:
(562) 941-5249
CITY:WHITTIERSTATE: CAZIP CODE:
90605
CAPACITY: 34CENSUS: 29DATE:
07/12/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:00 PM
MET WITH:Joel Alonzo TIME VISIT/
INSPECTION COMPLETED:
03:15 PM
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Licensing Program Analyst (LPA) Angelica Rea visited facility to conduct the annual inspection. LPA met with Administrator Joel Alonzo, who assisted with the visit.

There are 4 Units which are the client living quarters. Each unit has 2 stories. On the first floor of each unit, there is a living and dining area, kitchen, a bathroom which is shared by the clients and 2 bedrooms. The clients do not cook in the kitchens. Each bedroom has 2 beds. Upstairs, in each unit, there are 2 bedrooms, a bathroom which is shared by the clients, and a storage closet.

There is sufficient closet & drawer space in the client bedrooms; Smoke detectors were tested and are functioning properly; carbon monoxide detectors were tested and functioning properly; poisons, cleaning solutions, disinfectants are inaccessible to clients; toilets, hand washing and bathing facilities were inspected; LPA observed a sufficient supply of extra linen; personal hygiene items such as soap, toilet paper, toothbrush, toothpaste, and combs are available; sharp knives are locked in the kitchen of unit 4, & inaccessible to clients. Freezers and refrigerators are clean and required temperature is maintained; all clients’ medication were labeled and maintained as required and stored inaccessible to the clients. Hot water temperature was recorded to be 151 degrees F in Unit #3. Fire drill was conducted on 6/3/24.

LPA reviewed 3 client files and 3 staff files. LPA observed needs and services plans, admission agreements, physicians reports with TB test results, as well as other required documents. LPA also reviewed medication on today's visit.

Deficiency cited on 809-D. Exit interview conducted, copy of report and appeal rights were provided.
SUPERVISORS NAME: Lisa Hicks
LICENSING EVALUATOR NAME: Angelica Rea
LICENSING EVALUATOR SIGNATURE: DATE: 07/12/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/12/2024
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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Document Has Been Signed on 07/15/2024 02:57 PM - It Cannot Be Edited


Created By: Angelica Rea On 07/12/2024 at 02:43 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754

FACILITY NAME: VILLA FLORA
FACILITY NUMBER: 198601940

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/12/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
07/17/2024
Section Cited
CCR
80088(e)(1)

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(e) Faucets used by clients for personal care such as shaving and grooming shall deliver hot water.
(1) Hot water temperature controls shall be maintained to automatically regulate temperature of hot water delivered to plumbing fixtures used by clients to attain a hot water temperature of not less than 105 degrees F (40.5 degrees C) and not more than 120 degrees F (48.8 degrees C).
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Administrator will ensure that the water temperature measures between 105 degrees F and 120 degrees F as required. Administrator will send proof of correction to LPA by POC due date.
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This requirement was not met as evidenced by: LPA observed that hot water in Unit #3 measured at 151 degrees F, which poses a health and safety risk to clients in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Lisa Hicks
LICENSING EVALUATOR NAME:Angelica Rea
LICENSING EVALUATOR SIGNATURE:
DATE: 07/12/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/12/2024


LIC809 (FAS) - (06/04)
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