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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198602571
Report Date: 08/20/2021
Date Signed: 08/20/2021 12:13:45 PM

Document Has Been Signed on 08/20/2021 12:13 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:A AND M ARMOUR HOME CAREFACILITY NUMBER:
198602571
ADMINISTRATOR:BRITTANY JONESFACILITY TYPE:
735
ADDRESS:2145 ARMOUR STREETTELEPHONE:
(909) 618-7065
CITY:POMONASTATE: CAZIP CODE:
91768
CAPACITY: 4CENSUS: 3DATE:
08/20/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Brittany Jones, adminstratorTIME COMPLETED:
02:00 PM
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Licensing Program Analyst (LPA) Spencer conducted an unannounced annual inspection focusing on the Infection Control Domain. LPA Spencer was greeted by administrator Brittany Jones and discussed the purpose of today's visit. This single-story home contains four (4) bedrooms, two (2) bathrooms, a living room, kitchen, dining area, backyard, and detached garage.
The following was observed/inspected:
  • The facility had a universal entrance screening area including a thermometer, PPE supplies, screening logs, and sign-in sheet.
  • COVID-19 signage was placed in several areas of the facility.
  • Facility maintained a 30-day supply of PPE located in the supply closet and garage.
  • There was a sufficient supply of 2-day perishables and 7-day supply of non-perishable foods.
  • Cleaning solutions and sharps were locked and inaccessible.
  • Water temperature was measured in kitchen and bathrooms. Bathroom #2 water temperature read 121.4 degrees F. Staff immediately adjusted water meter and all areas measured within 105-120 F.
  • Each room contained required furniture including bed, dresser, night stand, lamp and chair.
  • Bathrooms contained hygiene supplies including liquid soap, paper towels, and toilet paper.
  • Medications were locked, centrally stored, and given as prescribed. Medications were reviewed for all residents and facility maintained a 30-day supply of medications.
  • Staff wore face masks throughout their shift.
  • Furniture and group activities were spaced to encourage physical distancing.
  • Smoke detectors/carbon monoxide detectors were present and operable.
  • A fire extinguisher was observed to be fully charged and last serviced January 2021.
  • Client files were inspected and emergency contact information was up to date.
  • Four (4) staff files were inspected and contained required health screenings, criminal record clearances, and training certificates. Administrator certificate expires 8/2022.


There were no deficiencies cited at this time. Technical violation issued on separate LIC9102 form. An exit interview was conducted and a copy of this report were provided to the administrator.
SUPERVISORS NAME: Christine Yee
LICENSING EVALUATOR NAME: LaJean Nicole Spencer
LICENSING EVALUATOR SIGNATURE: DATE: 08/20/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/20/2021
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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