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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198602080
Report Date: 08/01/2024
Date Signed: 08/01/2024 11:39:05 AM

Document Has Been Signed on 08/01/2024 11:39 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
GREATER LA AC/SC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754
FACILITY NAME:HOURGLASS HOMEFACILITY NUMBER:
198602080
ADMINISTRATOR/
DIRECTOR:
MARIA BINOTAPAFACILITY TYPE:
735
ADDRESS:1121 HOURGLASS PLACETELEPHONE:
(909) 631-8521
CITY:DIAMOND BARSTATE: CAZIP CODE:
91765
CAPACITY: 6CENSUS: 5DATE:
08/01/2024
TYPE OF VISIT:Case Management - Annual ContinuationUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:10 AM
MET WITH:Sheryl Sanchez, CaregiverTIME VISIT/
INSPECTION COMPLETED:
12:00 PM
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Licensing Program Analyst (LPA) Cynthia Chan conducted a subsequent visit to continue the annual inspection. LPA met with Administrator, Maria Binotapa, and explained the reason for the visit.

LPA conducted the remainder of the CARE tool domains during the visit today:
Staffing: There is sufficient staffing at the facility. Facility has an awake staff for the overnight shift to provide supervision to clients. Staff are fingerprint cleared and associated to the facility.
Personnel Records-Training: Staff files are maintained at the facility. LPA reviewed 3 personnel files and they all have the required documentation. Staff have current CPR/first aid training and sufficient on-going training. Administrator's (Maria Binotapa) certificate expires on 8/6/24. LPA provided a technical advisory for the HIV & TB training.
Client Rights: Facility has an internet access device for clients to use.
Client Records-Incident Reports: Client files are maintained at the facility. LPA reviewed (5) client files and their files contain the required documentation such as the admission agreement, IPP, medical assessment with TB results, Client rights, current IPP reports, and safeguarding of cash and inventory forms.
Incidental Medical & Dental: There is currently no client with a restricted health condition.
Disaster Preparedness: The facility has an Emergency Disaster Plan posted with contact numbers and at least 2 relocation sites. Disaster drills are conducted quarterly.
Emergency Intervention: Staff have the CPI training and only use techniques taught by the CPI instructor.
There are no deficiencies issued today. An exit interview was held and a copy of this report was given to the administrator.
SUPERVISORS NAME: Tony Vasallo
LICENSING EVALUATOR NAME: Cynthia D Chan
LICENSING EVALUATOR SIGNATURE: DATE: 08/01/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/01/2024
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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