198602995-6-12-2023-28-AS-JBAE-CSQQD3-20230612120404

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 198602995
Report Date: 06/12/2023
Date Signed: 06/12/2023 12:04:12 PM

Document Has Been Signed on 06/12/2023 12:04 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:	QFC LOVING CARE		FACILITY NUMBER:	198602995
ADMINISTRATOR:	ABESHYAN, HELEN		FACILITY TYPE:	740
ADDRESS:	13652 ALDERTON LN		TELEPHONE:	(562) 926-2802
CITY:	CERRITOS	STATE: CA	ZIP CODE:	90703
CAPACITY:	6	CENSUS: 6	DATE:	06/12/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	08:40 AM
MET WITH:	Administrator Helen Abeshyan		TIME COMPLETED:	12:15 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	On 6/12/23 at 8:30 a.m., Licensing Program Analyst (LPA) Jewel Baptiste conducted an unannounced Annual/Required inspection to QFC Upon arrival Loving Care Inc. LPA was greeted by Direct Support Professional (DSP) Maricel Neri who contacted the Administrator, Helen Abeshyan, at 8:45 a.m. to assist with today's visit. This home is licensed to serve age range 60 and over. Approved for 6 non-ambulatory, of which 1 may be bedridden. Hospice wavier for 2 residents. The last emergency disaster/fire drill was conducted on 5/23/2023. The Administrator Certificate expires on 7/14/2023, #6005527740. During today's visit LPA inspected the physical plant inside and outside, reviewed the food supply, tested the smoke/carbon monoxide detectors, reviewed (3) staff files, (6) client files, medications, and medication administration records for (6) clients. This home contains 4 bedrooms, 2 bathrooms, living room, office space, kitchen, dining room and an attached garage. LPA toured the physical plant with the DSP and observed all (6) client bedrooms, contained required furniture, lamps, dresser, chair, and closet space. The two bathrooms contain a working toilet, basin and water faucet, walk in shower with grab bar, shower chair, and bathmat. The temperature measured at 116.0F-116.7F. The smoke detectors were battery operated/wired, was individually tested, and observed to be working properly. The carbon monoxide detector was located in the hallway, tested, and functioning properly. There were (2) fire extinguishers located in kitchen and facility entrance fully charged and up to date. The kitchen was toured and contained working appliances; refrigerator, stove, oven and contained dishware, cups, plates, utensils, pots, and pans. knives secured in a draw in the kitchen. Cleaning agents and toxins locked underneath kitchen sink. The pantry was well stocked with canned goods, pasta, cereals, and the food supply contained a sufficient supply with a two-day supply of perishables and a seven-day supply of non-perishables that met title 22 guidelines. Walls and floors, cabinets and counters were clean and sanitary throughout the home. (Report continued on LIC809C.)

SUPERVISOR'S NAME: Lisa Hicks	TELEPHONE: (323) 213-1556
LICENSING EVALUATOR NAME: Jewel Baptiste	TELEPHONE: (323) 400-9594
LICENSING EVALUATOR SIGNATURE:	DATE: 06/12/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/12/2023

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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

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 CARE	FACILITY NUMBER: 198602995
	VISIT DATE: 06/12/2023

NARRATIVE

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The outdoor grounds were toured and inspected, and the patio was well maintained with shaded seating area accessible for client use. The garage contained a working washer and dryer, extra food, PPE supplies, emergency supply kits, toiletries, personal care supplies, and toxins and storage.

The facility contained notifications and postings: California Labor Laws, Emergency Disaster Plan, personal rights, facility license, business license, medical emergency information, let-us-know licensing contact information, consumer grievance, support services, community resources.

Exit interview conducted with Helen Abeshyan, Administrator, a copy of this report was provided.

SUPERVISOR'S NAME: Lisa Hicks	TELEPHONE: (323) 213-1556
LICENSING EVALUATOR NAME: Jewel Baptiste	TELEPHONE: (323) 400-9594
LICENSING EVALUATOR SIGNATURE:	DATE: 06/12/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/12/2023

LIC809 (FAS) - (06/04)

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