<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198602087
Report Date: 06/01/2023
Date Signed: 06/21/2023 03:23:41 PM

Document Has Been Signed on 06/21/2023 03:23 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:BEXLEY HOMEFACILITY NUMBER:
198602087
ADMINISTRATOR:RIA P. VILLANUEVAFACILITY TYPE:
735
ADDRESS:10708 BEXLEY DRIVETELEPHONE:
(562) 821-5429
CITY:WHITTIERSTATE: CAZIP CODE:
90606
CAPACITY: 4CENSUS: 3DATE:
06/01/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
03:30 PM
MET WITH:Ria Villanueva TIME COMPLETED:
05:30 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
Licensing Program Analyst (LPA) Angelica Rea made an unannounced visit to Bexley Home. The purpose of today’s visit was to conduct the required annual Inspection. On today’s visit LPA met with Administrator, Ria Villanueva. The home has 3 residents, 2 non-ambulatory, and 1 ambulatory. The facility conducted a fire and disaster drill on 5/5/23. There is 1 client currently hospitalized.

As a part of the inspection, LPA reviewed (3) client records, (3) staff files, and (2) client medications. Facility is a one story family home with four bedrooms, 3 of which are resident bedrooms. There are (2) bathroom(s) for client use. There is also a living room, a kitchen, a dining area, laundry area, and office area. There is a shaded area located in the backyard, with a patio set for client use. Front and back yard is in good condition at time of visit. Washer/Dryer appliances observed. Toxins and sharps locked and inaccessible to clients. There was sufficient perishable and non-perishable food observed.
Bedrooms #1-#3 are equipped with a beds, a dresser, lamp, chair, overhead lightning for each client. Bedroom #4 is a staff room/office. The facility has 2 bathrooms which have a working toilet, wash basin, and shower. Beds have the required linen/supplies which include, pillowcase, mattress padding, fitted sheet, blanket and bedspreads. Supply of hygiene supplies were observed. Smoke detectors and carbon monoxide detectors were tested and operational. Required postings observed. Water temperature measured between 105 degree F and 120 degree F.

No deficiencies cited. An exit interview was conducted and a copy of this report was provided to Administrator, Ria Villanueva.
SUPERVISORS NAME: Lisa Hicks
LICENSING EVALUATOR NAME: Angelica Rea
LICENSING EVALUATOR SIGNATURE: DATE: 06/01/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/01/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 1