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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198602087
Report Date: 05/28/2024
Date Signed: 05/28/2024 01:23:31 PM

Document Has Been Signed on 05/28/2024 01:23 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/
DIRECTOR:
RIA P. VILLANUEVAFACILITY TYPE:
735
ADDRESS:10708 BEXLEY DRIVETELEPHONE:
(562) 821-5429
CITY:WHITTIERSTATE: CAZIP CODE:
90606
CAPACITY: 4CENSUS: 4DATE:
05/28/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:00 AM
MET WITH:Ria Villanueva TIME VISIT/
INSPECTION COMPLETED:
01:30 PM
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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 4 residents, all of which are non-ambulatory. The facility conducted a fire and disaster drill on 5/1/24. There is 1 client currently in a skilled nursing facility.

As a part of the inspection, LPA reviewed (3) client records, (2) staff files, and (3) 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. The front and back yards are in good condition. Washer/Dryer appliances observed are functioning. Toxins and sharps are 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: 05/28/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/28/2024
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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