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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198602995
Report Date: 05/16/2022
Date Signed: 05/17/2022 10:28:51 AM


Document Has Been Signed on 05/17/2022 10:28 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:QFC LOVING CAREFACILITY NUMBER:
198602995
ADMINISTRATOR:ABESHYAN, HELENFACILITY TYPE:
740
ADDRESS:13652 ALDERTON LNTELEPHONE:
(562) 926-2802
CITY:CERRITOSSTATE: CAZIP CODE:
90703
CAPACITY:6CENSUS: 6DATE:
05/16/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
02:10 PM
MET WITH:Rodillo Legarto TIME COMPLETED:
04:40 PM
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Licensing Program Analyst (LPA) Nicol Wesley conducted an unannounced Required 1 year inspection at the facility and met with staff Rodillo Legarto and explained the purpose for todays visit. LPA Wesley interviewed Administrator Helen Abeshyan on the phone and she allowed staff to sign the report on her behalf. Prior to the visit LPA Wesley conducted a risk assessment for on-site inspections. The facility phone number is 562 926 2802.

The facility consist of (4) bedrooms, (2) bathrooms, living room, kitchen, dining area, office area, family room, back yard(covered patio with tables and chairs), and an attached garage. During the visit the Infection control domain was used and the following areas were observed/inspected: The facility had all postings at the front entrance, bathrooms, and throughout the facility. Hand sanitizing gel and masks were located at the entry of each room. A Pre screening area with PPE supplies was observed upon entry into the facility.

LPA conducted a complete tour of the facility, and observe the supply of food. Resident medications, and medication logs were reviewed. The smoke detectors/carbon monoxide detector are operable. LPA observed one fire extinguisher in the kitchen. The water temperature was tested and measured 116 degrees F. The mitigation plan was approved on 03/22/2021.

There were no deficiencies cited.

Exit interview conducted.
SUPERVISOR'S NAME: Lisa HicksTELEPHONE: (323) 981-3972
LICENSING EVALUATOR NAME: Nicol WesleyTELEPHONE: (323) 981-3975
LICENSING EVALUATOR SIGNATURE:
DATE: 05/16/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/16/2022
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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