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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198602544
Report Date: 07/30/2024
Date Signed: 07/30/2024 12:17:15 PM

Document Has Been Signed on 07/30/2024 12:17 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/
DIRECTOR:		ANGELA WILLIAMSFACILITY TYPE:
735
ADDRESS:431 FERRERO LNTELEPHONE:
(323) 330-7545
CITY:LA PUENTESTATE: CAZIP CODE:
91744
CAPACITY: 4CENSUS: 4DATE:
07/30/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:00 AM
MET WITH:Administrator Angela WilliamsTIME VISIT/
INSPECTION COMPLETED:
12:25 PM
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Licensing Program Analyst (LPA) Jose Villalobos conducted the required unannounced annual inspection. LPA met with Administrator, Angela Williams, and informed the reason for the visit today. The facility is licensed for 4 non-ambulatory adults, ages 18 through 59, and is vendorized through the San Gabriel/Pomona Regional Center.

LPA utilized the Compliance and Regulatory Enforcement (CARE) tools for the visit today. The following domains were completed:

Infection Control: Staff are using appropriate hand hygiene and wearing gloves when deemed necessary. Facility has an Infection Control Plan in place.

Operational Requirements: The fire clearance is approved for (4) non-ambulatory clients. Staff are adhering to operational requirements.

Physical Plant & Environment Safety: The home consists of 4 bedrooms, 2 bathrooms, living room, staff area, dining room, kitchen, laundry room, and a basement. The garage is detached and the spacious outdoor areas have tables and chairs for clients use. There are no pools or bodies of water on the premises. Knives, cleaning solutions, and disinfectants are locked and inaccessible to clients. There are no firearms or weapons stored at the facility. Water temperature measured within Title 22 regulations of 105-120 degrees.

Staffing: There is sufficient staffing at the facility. Administrator (Angela Williams) certificate expires on 12/30/25. Staff employed are over the age of 18 and are fingerprint cleared and associated to the facility.

Personnel Records-Training: Staff files are maintained at the facility. LPA reviewed six (6) staff files and they have current First Aid/CPR certification. Staff have their Health Screening and Tuberculosis Screening on file. Staff receive on-going training on a monthly basis.

Continued on 809-C page
SUPERVISORS NAME: Fernando Fierros
LICENSING EVALUATOR NAME: Jose Villalobos
LICENSING EVALUATOR SIGNATURE: DATE: 07/30/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/30/2024
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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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: 07/30/2024
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Client Rights-Information: Clients are informed of their personal rights. They are provided with individual tablets with internet access.

Client Records-Incident Reports: LPA reviewed all four (4) Client files, maintained at the facility. They have the required documentation such as Admission Agreement, Physician's Report (including T.B and Ambulatory Status), Consent forms, Individual Program Plan/IPP, Client Rights, Property Valuable and Cash resources forms.

Food Service: There are sufficient food supplies of 2-day perishable and (1) week of non-perishable items. The food is properly stored in the refrigerator. There are no clients on special diets. Pesticides and cleaning supplies are kept away from the food preparation areas. Kitchen is kept clean and free from rodents and other vermin. Plates, cups and utensils are kept cleaned and stored properly.

Health Related Services: The medications are centrally stored and in bubbled packs. LPA reviewed medications for all four (4) Clients. The facility uses the Medication Administration Record (MAR) log to document medications given. Medications are administered as prescribed by the Physician.

Incidental Medical Services: There are (0) clients with restricted health condition plan.

Disaster Preparedness: The facility has the current Emergency Disaster Plan in place. Last emergency drill was conducted on 7/17/24.

Emergency Intervention: Staff have CPI training and utilize de-escalation techniques. Manual restraints are only used if deemed necessary and will be reported when this technique is utilized.

There are no deficiencies issued today. An exit interview was held and a copy of this report was provided to the administrator.
SUPERVISORS NAME: Fernando Fierros
LICENSING EVALUATOR NAME: Jose Villalobos
LICENSING EVALUATOR SIGNATURE:

DATE: 07/30/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/30/2024
LIC809 (FAS) - (06/04)
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