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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198602901
Report Date: 03/24/2023
Date Signed: 03/24/2023 03:41:22 PM

Document Has Been Signed on 03/24/2023 03:41 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:LAYMAN FACILITYFACILITY NUMBER:
198602901
ADMINISTRATOR:HERNANDEZ, YESSICAFACILITY TYPE:
735
ADDRESS:4117 LAYMAN AVENUETELEPHONE:
(323) 346-3450
CITY:PICO RIVERASTATE: CAZIP CODE:
90660
CAPACITY: 4CENSUS: 4DATE:
03/24/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:35 PM
MET WITH:Administrator Yessica Hernandez TIME COMPLETED:
03:15 PM
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Licensing Program Analyst (LPA) Jose Villalobos made an unannounced Annual inspection focused on domains within the Compliance and Regulatory Enforcement (Care) Tools. On today’s visit LPA met with Administrator Yessica Hernandez and the purpose of the visit was discussed.

As a part of the inspection, LPA used the inspection tool, reviewed (4) client records, (3) staff files, and (4) client medications. Currently the facility has (4) clients which are ambulatory. The facility is vendorized through Eastern Los Angeles Regional Center. Facility is a one story family home with three (3) bedrooms of which (1) is for live in staff. There are (2) bathrooms of which (1) is for client use. There is also a living room, a den, a kitchen, central air and heating, a dining area, fire place locked and inaccessible to clients, a laundry room, a shaded area located in the backyard. A detached two (2) car garage inaccessible to clients. Front and back yard is in good condition at time of visit. Washer/Dryer appliances observed. Toxins and sharps locked and inaccessible to clients. Bedrooms #1-#2 are equipped with a (2) beds each, a dresser, lamp, chair, overhead lightning for each client. Bedroom #3 is for live in staff/Office Space. Bathroom #1 has a working toilet, wash basin, and shower. Bathroom #2 is attached to live in staff room. Beds have the required linen/supplies which include, pillowcase, mattress padding, fitted sheet, blanket and bedspreads. Supply of hygiene supplies stored in each client's bedrooms were observed. Fire alarms are interconnected and operational. Required postings observed. Water temperature within required tittle 22 regulations.

Inspection tool completed and there were no deficiencies. An exit interview was conducted and a copy of this report was provided to Administrator Yessica Hernandez.
SUPERVISORS NAME: Fernando Fierros
LICENSING EVALUATOR NAME: Jose Villalobos
LICENSING EVALUATOR SIGNATURE: DATE: 03/24/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/24/2023
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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