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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198601975
Report Date: 10/21/2022
Date Signed: 10/21/2022 12:51:34 PM

Document Has Been Signed on 10/21/2022 12:51 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
CCLD Regional Office, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754
FACILITY NAME:C & N GROUP CORPORATIONFACILITY NUMBER:
198601975
ADMINISTRATOR:CHRISTOPHER SORTOFACILITY TYPE:
735
ADDRESS:1249 N ARMELTELEPHONE:
(626) 498-0409
CITY:COVINASTATE: CAZIP CODE:
91722
CAPACITY: 6CENSUS: 4DATE:
10/21/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
08:45 AM
MET WITH:Staff#1 (S1)TIME COMPLETED:
01:00 PM
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Licensing Program Analyst (LPA) Tao conducted an unannounced annual inspection. The facility is licensed to serve six (6) Non-Ambulatory clients, (age 18-59). LPA was allowed entry by the facility staff#1. Administrator, Christopher Sorto joined the visit telephonically. San Gabriel Pomona Regional Center provides case management service to clients residing in this home. LPA discussed the purpose of today's visit. Facility annual fee is current.

During the visit, the inspection tool, infection control domain, including interviews with staff and clients was used, a tour of the facility was conducted; food supply was reviewed; and medications were reviewed.

LPA toured the facility inside and outside. The home is located in a residential neighborhood within the city of Covina and is a single-family house which consists of a living room, attached garage/storage, dining area, kitchen, three (3) client bedrooms and two (2) bathrooms.



The kitchen was clean and had maintained the required two (2) days perishable and seven (7) days non- perishable. All burners and stove tops were in working condition.

(-continued in LIC 809 C-)
SUPERVISORS NAME: Fernando Fierros
LICENSING EVALUATOR NAME: Bonnie Tao
LICENSING EVALUATOR SIGNATURE: DATE: 10/21/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/21/2022
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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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: C & N GROUP CORPORATION
FACILITY NUMBER: 198601975
VISIT DATE: 10/21/2022
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Clients’ bedrooms had beds, dressers, chairs and closet space available. Lamps/lights for each room were available to ensure the safety and comfort of all persons in the facility. Adequate linen and personal hygiene supply were observed. Client beds were in good condition and had appropriate linens. Bathrooms were clean and operable.

LPA also inspected facility common areas including the kitchen, living room, and dining room. Smoke detector combined with carbon monoxide detectors are dual detectors and functional. Last fire drill was conducted on 7/19/22. Fire extinguisher was fully charged. The first aid kit was fully stocked with a manual. There are no firearms on the premises and other dangerous weapons. Sharp items such as knives are locked in the kitchen cabinet. Comfortable temperature for clients was maintained. Hot water temperature measured at 107.5 degrees Fahrenheit which in compliance with Title 22 regulations

Pesticides/poisons were not stored in food areas, kitchen, or where kitchen equipment/utensils were stored.



Medications were centrally stored and locked in a storage room. 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 Staff, whose signature on this form confirm receipt of these documents.

SUPERVISORS NAME: Fernando Fierros
LICENSING EVALUATOR NAME: Bonnie Tao
LICENSING EVALUATOR SIGNATURE:

DATE: 10/21/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/21/2022
LIC809 (FAS) - (06/04)
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