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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198602544
Report Date: 08/03/2022
Date Signed: 08/03/2022 05:41:47 PM

Document Has Been Signed on 08/03/2022 05:41 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:AARON EATONFACILITY TYPE:
735
ADDRESS:431 FERRERO LNTELEPHONE:
(909) 287-3557
CITY:LA PUENTESTATE: CAZIP CODE:
91744
CAPACITY: 4CENSUS: 3DATE:
08/03/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
03:10 PM
MET WITH:Eden Tupuola TIME COMPLETED:
04:45 PM
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Licensing Program Analyst (LPA) Christine Wong conducted an unannounced annual required visit. LPA met with Lead Staff Eden Tupuola and explained the reason for the visit. LPA used the infection control tool to evaluate the facility. LPA observed the facility plant, COVID-19 procedures, reviewed clients' medications, observed food supply, and reviewed client and staff files.

The facility is a single story house and located up on the hill around the residential neighborhood area. The facility includes: staff office, art and craft room, living room, kitchen, four clients bedrooms, client bathroom, staff bathroom, laundry room, basement storage room and a detached garage. All 4 clients bedrooms were toured. Each bedroom has one bed, one chair, one drawer, required bed linen and furniture, sufficient lighting and closet space. The clients bathroom was toured and they are clean, sanitary and in a good working condition. The hot water temperature in client bathroom was tested at 109 degrees F. which is within the Title 22 regulation. The refrigerator in the kitchen, kitchen cabinet and basement storage room have sufficient for 2 days perishable and 7 days non-perishable food supply. All the appliances in the kitchen are clean and working properly. The sharp knives and utensils and knobs are locked in the kitchen cabinet which is inaccessible to clients. The common area such as living room and dining area are clean and have the required furniture. All the cleaning supplies are stored in the basement storage room and its locked and inaccessible to clients The front and back yard are maintained well and back yard have a shaded area for tables and chairs for clients to use it.

LPA reviewed 2 clients files to confirm emergency contact is updated. LPA also reviewed two staff files to confirm health screenings and fingerprint clearances. The two staff are all fingerprint cleared and also have an updated health screening updated on the personnel file. All clients medication are centrally stored and locked in the cabinet near the bedrooms. LPA inspected three clients' medication and all the medication are all seemed updated and accurate.
SUPERVISORS NAME: Christine Yee
LICENSING EVALUATOR NAME: Christine Wong
LICENSING EVALUATOR SIGNATURE: DATE: 08/03/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/03/2022
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)
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 FERRERO
FACILITY NUMBER: 198602544
VISIT DATE: 08/03/2022
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Facility is currently following COVID 19 recommendations regarding COVID 19 signs throughout the facility, disinfecting products are available in each bathroom and common area and facility is disinfected at least three times a day and every shift or every time the bathroom or kitchen has been used. The bathrooms have sufficient soap, paper towels, and signs. PPE supplies are sufficient for more than 30 days.

No deficiencies were found during this visit. Exit interview was conducted with Lead Staff Eden Tupuola and a copy of this report was provided.
SUPERVISORS NAME: Christine Yee
LICENSING EVALUATOR NAME: Christine Wong
LICENSING EVALUATOR SIGNATURE:

DATE: 08/03/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/03/2022
LIC809 (FAS) - (06/04)
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