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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198602019
Report Date: 05/03/2024
Date Signed: 05/03/2024 03:49:05 PM

Document Has Been Signed on 05/03/2024 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
GREATER LA AC/SC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754
FACILITY NAME:PEOPLE'S CARE COVINA HILLSFACILITY NUMBER:
198602019
ADMINISTRATOR/
DIRECTOR:		RAMOS, JOLLIEREY (JOLLIE)FACILITY TYPE:
735
ADDRESS:1412 E COVINA HILLS RDTELEPHONE:
(626) 498-0075
CITY:COVINASTATE: CAZIP CODE:
91724
CAPACITY: 4CENSUS: 3DATE:
05/03/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:30 AM
MET WITH:Jollie Ramos, AdministratorTIME VISIT/
INSPECTION COMPLETED:
04:00 PM
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Licensing Program Analyst (LPA) Cynthia Chan conducted the required annual inspection using the Compliance and Regulatory Enforcement (CARE) tool. LPA arrived unannounced and met with Administrator, Jollie Ramos. The purpose for the visit was explained. The facility is licensed to serve four (4) non-ambulatory clients, ages 18-59. Facility is approved for delayed egress and secured perimeters. All 3 clients residing at this home receive services provided by the San Gabriel/Pomona Regional Center.

LPA toured the facility and observed the following: The facility consists of 4 client bedrooms, 2 bathrooms, living room, dining room, activity room. kitchen, laundry room, office area, and attached garage. The backyard has a shaded area for client. Each of the client bedrooms has the required furniture and lighting. Sufficient supply of perishable and non-perishable foods are observed. Adequate linen and personal hygiene supplies are observed. There are smoke and carbon monoxide combo detectors located throughout the house and are interconnected. Staff are continuing to sanitize and clean at least 3 times daily. Knives and cleaning products are locked in cabinets. Clients are provided with internet service and facility has a device available for clients usage. LPA reviewed 3 client files and their medications. They have the required documents including the medical assessment with TB results. Medications are centrally stored and locked in the kitchen cabinet. The medications are administered as prescribed. LPA reviewed 3 Staff files. Staff have current CPR & First Aid certificates and are receiving on-going training. There are 2 awake staff for the overnight shift providing supervision to clients. Facility conducts monthly disaster drills and are documented. There are no clients with a restricted or prohibited health condition. Staff do not utilize any manual restraints.
No deficiencies were observed. A copy of this report was given to the administrator.
SUPERVISORS NAME: Tony Vasallo
LICENSING EVALUATOR NAME: Cynthia D Chan
LICENSING EVALUATOR SIGNATURE: DATE: 05/03/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/03/2024
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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