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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198602400
Report Date: 11/26/2024
Date Signed: 11/26/2024 10:28:52 AM

Document Has Been Signed on 11/26/2024 10:28 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:GOODEN RESIDENTIAL WELLNESS CENTER, THEFACILITY NUMBER:
198602400
ADMINISTRATOR/
DIRECTOR:
MITCHELL, CORY BFACILITY TYPE:
772
ADDRESS:378 N EL MOLINO AVETELEPHONE:
(626) 657-8853
CITY:PASADENASTATE: CAZIP CODE:
91101
CAPACITY: 6CENSUS: 3DATE:
11/26/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:05 AM
MET WITH:Travis Whalen - Staff TIME VISIT/
INSPECTION COMPLETED:
10:45 AM
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Licensing Program Analyst (LPA) Mary Flores conducted an unannounced annual visit at the facility using the CARE inspection tool. LPA met with Travis Whalen and explained the reason for the visit.
The facility is an adult residential licensed to serve a total of six (6) ambulatory adults as a transitional residential program. Facility is a two story home consisting of a living room, kitchen, dining room, activity room, one half bathroom, and an office downstairs. Upstairs there are three bedrooms, two full baths, a laundry room, (2) supply rooms/closets, patio with detached garage, and a backyard.

LPA conducted a tour of the facility with Travis Whalen and observed the following:
Home is good repair indoor and outdoor. Each common area is in clean and furniture is in good repair. Facility has a food preparation waiver and meals get prepare in the main house and delivered to the facility. Kitchen is used to store snacks only and facility keeps a container with emergency food supplies is store in the basement. Each bedroom has the required furniture, bedding supplies, and sufficient lighting. Bathrooms (3) are in working condition, water temperature was tested and tested as follow bathroom #1 tested at 103.1 degrees F., and bathroom #2 tested at 101.6 degrees F. which is not within the required 105-120 degrees F. Cleaning supplies are store in a lock closet, and medications and sharps are stored in the office in cabinets with a lock. Detached garage has been converted into a gym. No large bodies of water were observed in the property. Backyard is clean and free of obstructions with sufficient shaded seating area. Smoke/Carbon Monoxide detectors were tested and in working condition. Fire extinguishers were observed and last checked on 11/17/23. Last fire drill was conducted on 9/30/24. Evacuation chair was observed in linen closet.
Emergency Disaster plan and Infection Control plan were reviewed and current. LPA reviewed medication and files for 3 clients and files for 5 staff. LPA interviewed 1 client and 2 staff. Administrator certificate was reviewed for Cory Mitchell #6069942735 exp. date: 9/11/25.
No deficiencies were noted during this visit. Exit interview was conducted with Cory Mitchell and a copy of this report was provided.
SUPERVISORS NAME: Tony Vasallo
LICENSING EVALUATOR NAME: Mary G Flores
LICENSING EVALUATOR SIGNATURE: DATE: 11/26/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/26/2024
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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