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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198601975
Report Date: 11/04/2024
Date Signed: 11/04/2024 02:06:57 PM

Document Has Been Signed on 11/04/2024 02:06 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/
DIRECTOR:		CHRISTOPHER SORTOFACILITY TYPE:
735
ADDRESS:1249 N ARMELTELEPHONE:
(626) 498-0409
CITY:COVINASTATE: CAZIP CODE:
91722
CAPACITY: 6CENSUS: 5DATE:
11/04/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:15 AM
MET WITH:S1, staff in chargeTIME VISIT/
INSPECTION COMPLETED:
12:45 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 met with staff#1. San Gabriel Pomona Regional Center provides case management service to clients residing in this home. LPA discussed the purpose of today's visit to staff#1 (S1) and to administrator over the phone.

The inspection consisted of applying CARE tool, interviewing staff/clients, conducting physical plant, checking food supply and reviewing medications/staff files/client files. 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 required two (2) days perishable and seven (7) days non- perishable were observed. Clients’ bedrooms had the required furnishing and in compliance. Adequate linen and personal hygiene supply were observed. Smoke detectors were combined with carbon monoxide detectors are operational. Last fire drill was conducted on 09/30/24. Fire extinguisher was fully charged. Hot water temperature measured at 117.5 degrees Fahrenheit which in compliance with Title 22 regulations. Medications were centrally stored, locked in a storage room, and medication records were properly logged and current.

No deficiencies were cited per California Code of Regulations, Title 22, Division 6. An exit interview was conducted and a copy of the report were provided to staff#1.
SUPERVISORS NAME: Fernando Fierros
LICENSING EVALUATOR NAME: Bonnie Tao
LICENSING EVALUATOR SIGNATURE: DATE: 11/04/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/04/2024
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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