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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198602564
Report Date: 09/09/2020
Date Signed: 09/11/2020 02:31:30 PM

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:ROYAL VISTA SAN GABRIELFACILITY NUMBER:
198602564
ADMINISTRATOR:FUENTES, SUSANAFACILITY TYPE:
740
ADDRESS:901 W SANTA ANITA STTELEPHONE:
(626) 289-8889
CITY:SAN GABRIELSTATE: CAZIP CODE:
91776
CAPACITY:100CENSUS: 58DATE:
09/09/2020
TYPE OF VISIT:OfficeANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:David Allen, Vice PresidentTIME COMPLETED:
10:30 AM
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Regional Manager Araceli Ramirez, Licensing Program Manager (LPM) Adeline Ho, and Licensing Program Analyst (LPA) Galarza scheduled a teleconference meeting. Due to the situation surrounding the Coronavirus Disease 2019 (COVID-19), and to implement mitigation measures, today’s meeting was conducted telephonically with Vice President of Finance David Allen, and Administrator Susana Fuentes.

The purpose of the meeting was to discuss, and re-enforce LA County Department of Public Health (DPH) COVID-19 outbreak guideline recommendations provided to the facility during the on-site visit conducted on 9/2/2020 by LA County Department of Public Health ACDC Medical Doctor team. Two (2) previous teleconference meetings dates: 8/18/20 & 8/21/20 were held with licensees, and Administrator to discuss DPH recommendations and continued technical support provided to Administrator by CCL and DPH and minimize the spread of COVID-19.

Regional Manager discussed the importance of following LA County Department of Public Health guidelines, and CCL's continued technical support in order to stop further outbreak spread. Facility representatives were informed that CCL is re-enforcing all Public Health guidelines, and ensure they are being followed as directed.

Administrator stated that all recommendations have been put into place. Facility continues to use staffing agency, and is providing on-going staff training. Infection control measures are in place. Vice President stated the corporate office has resources available in order to assist Administrator if needed.

Accuracy and timeliness of daily reports required by LA County Department of Public Health, and CCL were discussed. Regional Manager communicated to VP that corporate office shall ensure that additional resources are provided to Administrator if needed, in order for all reporting requirements to be met as directed, and Administrator is responsive to all LA County Department of Public Health, and CCL requests.

See LIC 812C for continuation of report.
SUPERVISOR'S NAME: Wei Siew HoTELEPHONE: (323) 981-3969
LICENSING EVALUATOR NAME: Noemi GalarzaTELEPHONE: (323) 981-3974
LICENSING EVALUATOR SIGNATURE:

DATE: 09/09/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/09/2020
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: ROYAL VISTA SAN GABRIEL
FACILITY NUMBER: 198602564
VISIT DATE: 09/09/2020
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Below are LA County Department of Public Health recommendations discussed:
  • Follow Interim Guidance for US Institutions of Higher Education on working with state and local health officials to isolate ill persons and provide temporary housing as needed.
  • Close off areas visited by the ill persons. Open outside doors and windows and use ventilating fans to increase air circulation in the area. Wait 24 hours or as long as practical before beginning cleaning and disinfection.
  • In areas where ill persons are being housed in isolation, follow Interim Guidance for Environmental Cleaning and Disinfection for U.S. Households with Suspected or Confirmed Coronavirus Disease 2019. This includes focusing on cleaning and disinfecting common areas where staff/others providing services may come into contact with ill persons but reducing cleaning and disinfection of bedrooms/bathrooms used by ill persons to as needed.
  • In areas where ill persons have visited or used, continue routine cleaning and disinfection as in this guidance.
  • If it has been more than 7 days since the person with suspected/confirmed COVID-19 visited or used the facility, additional cleaning and disinfection is not necessary.
  • Move/remove all furniture that is not spaced at least 6 feet.
  • If activities are provided, limit group activities to allow for 6 feet social distancing at all times (and greater distances if residents are not complying with mask wearing).
  • All group activities/meals should occur outdoors or individual bedrooms as able; subject to change due to weather conditions.


Regional Manager informed facility representatives that failure to comply with recommendations, and guidelines may result in Title 22 regulation citations.

Vice President and Administrator were informed that a LIC 809 report would be generated. A hard copy of the report was emailed to Mr. Allen. He was instructed to sign the LIC 809 report and return to LPA. In addition, a copy of the report was emailed to Administrator Susana Fuentes.

SUPERVISOR'S NAME: Wei Siew HoTELEPHONE: (323) 981-3969
LICENSING EVALUATOR NAME: Noemi GalarzaTELEPHONE: (323) 981-3974
LICENSING EVALUATOR SIGNATURE:

DATE: 09/09/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/09/2020
LIC809 (FAS) - (06/04)
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