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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198602852
Report Date: 03/23/2022
Date Signed: 03/23/2022 11:36:57 AM

Document Has Been Signed on 03/23/2022 11:36 AM - 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 ROSEMEADFACILITY NUMBER:
198602852
ADMINISTRATOR:KRISTINE PANAMENOFACILITY TYPE:
775
ADDRESS:1280 SAN GABRIEL BLVDTELEPHONE:
(626) 802-5889
CITY:ROSEMEADSTATE: CAZIP CODE:
91770
CAPACITY: 60CENSUS: 0DATE:
03/23/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
08:43 AM
MET WITH:Maryrose Napoles, District ManagerTIME COMPLETED:
11:50 AM
NARRATIVE
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Licensing Program Analyst (LPA) Galarza conducted an unannounced Required- 1 year visit focusing on COVID-19 Infection Control Practices. LPA explained the purpose of the visit to Administrator Kristine Panameno, and Day Program Supervisor Xenia Carreon. District Manager Maryrose Napoles arrived later. The Day Program is licensed to serve 60 developmentally disabled adults ages 18 and over, of which 18 clients may be non-ambulatory. During the today's visit, LPA toured the physical plant. The facility provides transportation services and is equipped with nine (9) vans.

Physical Plant: Facility is a one story building consisting of a lobby area, nine (9) training/activity rooms [communication room, well-ness center, music studio, recreation, media center, creative studio, computer lab, independent living, home economics/kitchen/cafe, 6 restrooms [included 1 changing room], 2 offices, storages rooms, and 3 exits. It has a community integration component. The last disaster drill was conducted on 2/10/2022. The facility's last fire inspection was conducted on 1/20/2022.
  • Due to the COVID-19 pandemic in-person programming has resumed. Services are provided remotely.
  • COVID-19 Infection Control signs to promote hand washing, cough/sneeze etiquette, and physical distancing were observed in the entrance, common areas, hallways, and bathrooms. LPA was screened upon entry by staff. Facility has an approved COVID-19 mitigation plan.
  • Disinfectant products are available in each room. Restrooms have hand washing signs, soap, paper towels, and trash cans.
  • The Wellness Center will be used as an COVID-19 isolation room if needed.
  • Personal Protective Equipment (PPE's) and emergency supplies of more than 30 days were observed.
  • Staff were observed wearing masks. Staff and client files were not reviewed during today's visit. No medication records were reviewed due to zero client census.
  • A posted Emergency Disaster Plan and emergency food supply and water were observed.
NOTE: Administrator on record does not have clearance to work; request is pending. Per, Maryrose Napoles at this time Administrator is only overseeing district wide COVID testing responsibilities, and is not acting as Administrator. Deficiency was cited. Civil penalties were assessed. A copy of the report/appeal rights were issued. Exit interview was conducted with District Manager Maryrose Napoles.
SUPERVISORS NAME: Lisa Hicks
LICENSING EVALUATOR NAME: Noemi Galarza
LICENSING EVALUATOR SIGNATURE: DATE: 03/23/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/23/2022
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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Document Has Been Signed on 03/23/2022 11:36 AM - It Cannot Be Edited


Created By: Noemi Galarza On 03/23/2022 at 10:29 AM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754

FACILITY NAME: PEOPLE'S CARE ROSEMEAD
FACILITY NUMBER: 198602852

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/23/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Deficiency Dismissed
Type A
Section Cited
CCR
82019(e)(2)
Criminal Record Clearance. Prior to working, residing or volunteering in a licensed day program, all individuals subject to a criminal record review pursuant to Health and Safety Code Section 1522 shall do the following: Obtain a California clearance or a criminal record exemption as required by the Department.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, the licensee did not comply with the section cited above in that Administrator on record began working at the site without obtaining criminal record exemption clearance, which poses an immediate health, safety or personal rights risk to persons in care. Administrator began working at the facility July 2021.
POC Due Date: 03/24/2022
Plan of Correction
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Licensee shall submit proof that an exemption request was submitted to CBCB for staff (S1)/Administrator. Staff must be not work at licensed facilities until it has received criminal record clearance.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Lisa Hicks
LICENSING EVALUATOR NAME:Noemi Galarza
LICENSING EVALUATOR SIGNATURE:
DATE: 03/23/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/23/2022


LIC809 (FAS) - (06/04)
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