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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198602208
Report Date: 05/23/2024
Date Signed: 05/23/2024 04:21:50 PM

Document Has Been Signed on 05/23/2024 04:21 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:ELEANOR RICHARDSON HOMEFACILITY NUMBER:
198602208
ADMINISTRATOR/
DIRECTOR:
HOLLAND, TRAVISFACILITY TYPE:
735
ADDRESS:462 E GROVE STTELEPHONE:
(909) 398-4488
CITY:POMONASTATE: CAZIP CODE:
91768
CAPACITY: 3CENSUS: 3DATE:
05/23/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
02:33 PM
MET WITH:Kelvin Torrent, DSPTIME VISIT/
INSPECTION COMPLETED:
04:25 PM
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Licensing Program Analyst (LPA) Cynthia Chan conducted the annual inspection on 5/23/24. LPA arrived unannounced and met with Staff, Kelvin Torrent. The purpose of the visit was explained. Administrator, Jose Alderete, arrived shortly thereafter to assist with the visit. The facility is licensed for (3) adults, ages 18 - 59, and of which (1) may be non-ambulatory.

LPA inspected the facility using the Compliance and Regulatory Enforcement (CARE) tool. The following were observed:
Infection Control: Staff are continuing to clean and disinfect during each shift and more often for high touched surfaces. Staff are wearing gloves when deemed necessary. Facility has submitted the Infection Control Plan and is providing annual training to staff. Physical Plant & Environment Safety: The facility consist of 3 client bedrooms, 1 administrator's office, 2 bathrooms, living room, dining area, kitchen, and an attached garage. Each client bedroom has the required furniture and bedding. Extra hygiene supplies and linens are observed. Knives, cleaning solutions, and disinfectants are locked, making them inaccessible to clients. There is no swimming pool on the premises. The hot water temperature was measured between 105-120 degrees F. Operational Requirements: The facility is operating within the approved fire clearance. There are 3 ambulatory clients residing at the home. Staff are providing the care and supervision as necessary to meet the clients' needs. Food Service: There are sufficient food supplies of 2 day perishable and a week of non-perishable. The kitchen is clean and free of pests. Staffing: There is sufficient staffing to provide care and supervision to the 6 clients. There is also an awake staff in the overnight shift. Personnel Records-Training: LPA reviewed 4 personnel files. The administrator's certificate expires on 6/19/24. Staff files contain the required documents and have current CPR & First Aid certificates. All the staff are fingerprint cleared and associated to the facility.
There was no deficiency observed today. LPA will return another day to complete the inspection. A copy of this report was given to the administrator.
SUPERVISORS NAME: Tony Vasallo
LICENSING EVALUATOR NAME: Cynthia D Chan
LICENSING EVALUATOR SIGNATURE: DATE: 05/23/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/23/2024
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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