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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198602544
Report Date: 09/03/2021
Date Signed: 09/03/2021 08:08:59 PM

Document Has Been Signed on 09/03/2021 08:08 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:PEOPLE'S CARE FERREROFACILITY NUMBER:
198602544
ADMINISTRATOR:URBAYAN, ARVINFACILITY TYPE:
735
ADDRESS:431 FERRERO LNTELEPHONE:
(909) 287-3557
CITY:LA PUENTESTATE: CAZIP CODE:
91744
CAPACITY: 4CENSUS: 4DATE:
09/03/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:28 PM
MET WITH:URBAYAN, ARVINTIME COMPLETED:
03:45 PM
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Licensing Program Analyst (LPA) Christine Wong conducted an annual required visit. LPA met with House Manager Rhys Espinosa and explained the reason for the visit. Shortly after, the administrator Arvin Urbayan arrived and assist with the visit, On today's annual inspection, LPA used the infection control tool to evaluate the facility. LPA observed the facility plant, COVID-19 procedures and observed food supply. Facility has submitted a mitigation plan and was approved on 04/10/21

The facility is a single story home located in the neighborhood area. The facility consists of four clients' bedrooms, two bathrooms, staff office, kitchen, first living room, second living room, dining room, laundry room and basement for storage. Each client bedroom has one bed, closet, drawer, night stand, chair and adequate lighting. The facility also has sufficient linen supply including, mattress pads. All toilets, hand washing and showers are safe, sanitary and in good operation condition. The hot water temperature at the two bathrooms were measured between 115 and 115.7 degrees F. The smoke detectors and carbon monoxide detectors are interconnected and all operational. LPA observed ample food supply of two (2) days of perishables and seven (7) days of non-perishables in the kitchen and the basement. Storage areas for cleaning solutions, toxic, knives, and hazardous items were secured and made inaccessible to clients. There is an outside shaded area including table and chairs for client use, outdoor space is clean and clear of obstructions or clutter.

Facility is currently following COVID 19 recommendations including COVID 19 signs throughout the facility, social distancing between clients and staff, disinfecting products are available around the facility and facility is disinfected more than once per day, restrooms have sufficient soap, paper towels, and signs and PPE supplies are stored for more than 30 days.

No deficiencies were found during this visit. Exit interview was conducted with administrator Arvin Urbayan and a copy of this report was provided.
SUPERVISORS NAME: Christine Yee
LICENSING EVALUATOR NAME: Christine Wong
LICENSING EVALUATOR SIGNATURE: DATE: 09/03/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/03/2021
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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