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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198602852
Report Date: 05/25/2023
Date Signed: 05/25/2023 04:38:15 PM

Document Has Been Signed on 05/25/2023 04:38 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
GREATER LA AC/SC, 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: 27DATE:
05/25/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
02:05 PM
MET WITH:Xenia Carreon, SupervisorTIME COMPLETED:
04:45 PM
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Licensing Program Analyst (LPA) Cynthia Chan conducted the required annual inspection using the CARE tools. LPA met with Day Program Supervisor, Xenia Carreon and explained the reason for visit. The Program Director, Kristine Panameno, arrived shortly thereafter to assist with the visit. The day program is licensed for 60 clients, ages 18-59, of which 18 may be non-ambulatory.

LPA toured the facility and inspected/observed the following:
Infection Control: The facility has sufficient supplies of PPE and utilizing gloves when necessary to assist participants. They are performing proper hand hygiene before and after caring for clients and providing snacks. Staff are cleaning and disinfecting surfaces regularly to keep the facility clean. Physical Plant & Environmental Safety: The facility consists of a lobby area, ten (10) training/activity rooms {communication room, well-ness center, music studio, recreation, media center, creative studio, computer lab, independent living, home economics/kitchen, boutique}, 10 restrooms, 2 offices, storages rooms, and 3 exits. The facility is clean, sanitary, and in good repair. Disinfectants and cleaning solutions are properly stored and locked. The hot water temperature is measured within the required range of 105 - 120 degrees F. Operational Requirements: The facility is operating within the approved fire clearance. Staffing: The staffing is maintained at a 1 staff to 3 participants as specified by the regional center. Personnel Records - Training: LPA reviewed 4 Staff records and they have the required documentation in their files. The CPR/First aid certificates are current and associated to the facility. Staff are provided with in-service training at least once a month. Client Records - Incident Reports: LPA reviewed 4 Client files and the files consist of the admission agreement, medical assessment with TB test result, consent forms, and current IPP. Client Rights - Information: Participants do not utilize any postural supports. Food Service: Clients bring in lunch from home daily and facility only provide snacks. Health-Related Services: No clients are taking medication during program hours. Incidental Medical Services: The facility does not currently have any participants in attendance with a restricted health condition. Disaster Preparedness: Facility has the updated LIC610D form with emergency contact numbers, shutoff valves, and relocation sites. Emergency Intervention: Staff have CPI training and do not utilize manual restraints at the site.
No deficiencies issued. A copy of this report was given to the Program Director.
SUPERVISORS NAME: Tony Vasallo
LICENSING EVALUATOR NAME: Cynthia D Chan
LICENSING EVALUATOR SIGNATURE: DATE: 05/25/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/25/2023
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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