198602183-2-11-2025-28-AS-EZAA-DDT2NG-20250211163243

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 198602183
Report Date: 02/11/2025
Date Signed: 02/11/2025 04:33:06 PM

Document Has Been Signed on 02/11/2025 04:33 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:	JORDAN GUEST HOME		FACILITY NUMBER:	198602183
ADMINISTRATOR/ DIRECTOR:	BOHANAN, VILMA TRAZO		FACILITY TYPE:	740
ADDRESS:	10657 JORDAN ROAD		TELEPHONE:	(562) 822-4677
CITY:	WHITTIER	STATE: CA	ZIP CODE:	90603
CAPACITY: 6	TOTAL ENROLLED CHILDREN: 0	CENSUS: 5	DATE:	02/11/2025
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	03:05 PM
MET WITH:	Vilma Bohanan - Administrator		TIME VISIT/ INSPECTION COMPLETED:	04:45 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) Erik Zaragoza conducted an unannounced required one-year annual inspection at the facility. LPA met with Vilma Bohanan, administrator for the facility, and explained the purpose of the visit. During today's visit, LPA conducted a tour of the home including the living room, kitchen, laundry room, four (4) resident bedrooms, and two (2) resident restrooms which had a hot water temperatures of 109.3 Degrees Fahrenheit and 106.8 Degrees Fahrenheit. Medications for the residents were also reviewed. During a tour of the backyard area of the facility, the pool area was found to be unlocked and unattended. Due to time constraints, the annual inspection will need to be completed at a later date. The deficiency cited today will be marked on the LIC809D page. Exit interview held and a copy of the report along with appeal rights were provided.

David Sicairos	TELEPHONE: (323) 981-3982
Erik Zaragoza	TELEPHONE: (323) 981-3983
	DATE: 02/11/2025

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/11/2025

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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Document Has Been Signed on 02/11/2025 04:33 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

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: JORDAN GUEST HOME	FACILITY NUMBER: 198602183
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 02/11/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Section Cited

CCR

87307(e)(2)(A)

(e) The licensee shall supervise residents as needed and as determined by the resident's appraisal pursuant to Section 87457, Pre-Admission Appraisal or Section 87463 Reappraisals, when residents are in proximity to or when there is use of the following items: (2) Fishponds, wading pools, hot tubs, swimming pools, or similar larger bodies of water. (A) The licensee shall ensure that the bodies of water specified above are inaccessible through fencing, covering, or other means when not in active use by residents. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation, the licensee did not comply with the section cited above in 5 out of 5 residents, as the pool area which contained a full body of water was unlocked during the physical plant tour, which poses an immediate health, safety or personal rights risk to persons in care.
	POC Due Date: 02/12/2025
	Plan of Correction
1 2 3 4	POC Cleared during visit Administrator is to ensure that the pool is locked when not in use at all time. Administrator is to lock the pool area and submit photogrpahic proof to LPA by the POC due date.

Section Cited


	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

David Sicairos	TELEPHONE: (323) 981-3982
Erik Zaragoza	TELEPHONE: (323) 981-3983
	DATE: 02/11/2025

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/11/2025

LIC809 (FAS) - (06/04)

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