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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198603045
Report Date: 01/24/2025
Date Signed: 01/24/2025 04:44:29 PM

Document Has Been Signed on 01/24/2025 04:44 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:WHITE ROSE GUEST HOMEFACILITY NUMBER:
198603045
ADMINISTRATOR/
DIRECTOR:
CLAUDIA CONTRERASFACILITY TYPE:
735
ADDRESS:19161 ALDORA DRTELEPHONE:
(626) 581-8358
CITY:ROWLAND HEIGHTSSTATE: CAZIP CODE:
91748
CAPACITY: 4CENSUS: 4DATE:
01/24/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:40 PM
MET WITH:Francine Campana, AdministratorTIME VISIT/
INSPECTION COMPLETED:
04:30 PM
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Licensing Program Analyst (LPA) Cynthia Chan conducted the unannounced annual inspection. LPA met with the administrator, Francine Campana, and provided the reason for the visit. The facility is licensed to serve 4 adults ages 18 through 59, of which 3 may be non-ambulatory. The home is vendorized by the San Gabriel/Pomona Regional Center.

LPA inspected the facility using the Compliance and Regulatory Enforcement (CARE) tool and observed the following:
The single story facility consists of 4 client bedrooms, 2 bathrooms, living room, dining room, kitchen, and an attached garage. There is no swimming pool on the premises and no items obstructing the walkways. The facility has smoke and carbon monoxide combo detectors throughout the home. LPA observed sufficient food supplies of perishable and nonperishable. Knives and cleaning solutions are locked and inaccessible to clients. The hot water temperature is measured within the required range of 105-120 degrees F. Staff are continuing to clean and disinfect throughout the day.
There are 4 ambulatory clients residing at the home. LPA reviewed files for all 4 clients and the required documents are maintained in their files. Medications were also reviewed and are being given as prescribed by the physician. LPA reviewed the administrator and 2 other staff files. Administrator's certificate expires on 2/22/25. Staff have current CPR & First Aid certificates. Staff are receiving on-going training. Facility has an Emergency and Disaster Plan and conducting monthly drills. LPA advised administrator to conduct the drills for each shift.

No deficiencies were issued today. An exit interview was held and a copy of this report was given to the administrator.
SUPERVISORS NAME: Tony Vasallo
LICENSING EVALUATOR NAME: Cynthia D Chan
LICENSING EVALUATOR SIGNATURE: DATE: 01/24/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/24/2025
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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