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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198602007
Report Date: 10/24/2022
Date Signed: 10/24/2022 10:40:04 AM

Document Has Been Signed on 10/24/2022 10:40 AM - 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:ALKEN CAREFACILITY NUMBER:
198602007
ADMINISTRATOR:RUALO, MARIA THERESA C.FACILITY TYPE:
735
ADDRESS:13649 FLATBUSH AVENUETELEPHONE:
(562) 929-7382
CITY:NORWALKSTATE: CAZIP CODE:
90650
CAPACITY: 4CENSUS: 4DATE:
10/24/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Licensee- Maria RauloTIME COMPLETED:
11:00 AM
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Licensing Program Analyst (LPA) Ashley Calderon conducted an unannounced annual visit to the above facility. LPA Calderon met with Licensee/ Administrator Maria Raulo and discussed the purpose of todays visit.

During the visit LPA Calderon conducted a full tour of the facility. LPA toured the physical plant with Raulo. The facility consist of 4 bedrooms, 2 bathrooms, living room, dining room, kitchen, laundry area in the attached garage and an outdoor shaded backyard area free of bodies of water. A pre-screening area with PPE supplies was observed upon entry into the facility. LPA Calderon used the Infection Control domain and the following areas were observed/inspected: The facility had all postings at the front entrance, bathrooms, and throughout the facility. Hand sanitizing gel and masks were located for the use of staff and clients. Residents bedrooms were cleaned and free of debris and clutter, having proper bed lining, adequate lighting and good equipped furniture. LPA conducted observe supply of non-perishable and perishable food items. LPA Calderon reviewed client's medications, and medication logs. The smoke detectors/carbon monoxide detector are operable. LPA observed one fire extinguisher in the kitchen, that was fully charged. The water temperature was tested in the kitchen and measured at 116.2 degrees F, bathroom #1 hot water measured at 119.6 degrees F, and bathroom # 2 hot water measured at 118.3 degrees F. Fire Drill was done on 9/10/22 and Raulo continues to provide staff and clients on Covid-19 prevention information and updates. On 5/24/22 Raulo conducted a training to staff on Infection Prevention Control.

Administrators certificate for Maria Rualo #6019511735, expires on 07/27/2024.

There were no deficiencies cited. An exit interview was held and a copy of todays report was provided.
SUPERVISORS NAME: Fernando Fierros
LICENSING EVALUATOR NAME: Ashley Calderon
LICENSING EVALUATOR SIGNATURE: DATE: 10/24/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/24/2022
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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