<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198603226
Report Date: 07/16/2024
Date Signed: 07/16/2024 03:33:54 PM

Document Has Been Signed on 07/16/2024 03:33 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:INSIGHT FOR LIFE @3RD AVEFACILITY NUMBER:
198603226
ADMINISTRATOR/
DIRECTOR:
ESCORCIA, ROGERFACILITY TYPE:
737
ADDRESS:549 S. 3RD AVETELEPHONE:
(626) 945-2709
CITY:LA PUENTESTATE: CAZIP CODE:
91746
CAPACITY: 3CENSUS: 3DATE:
07/16/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:10 PM
MET WITH:Roger Escorcia - AdministratorTIME VISIT/
INSPECTION COMPLETED:
03:45 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
Licensing Program Analysts (LPA) Nune Margaryan conducted an unannounced annual visit using the Care Tool. LPA met with Administrator Roger Escorcia and explained the reason for the visit. The physical plant was inspected along with medications, food supply, and resident and staff records.
The facility is licensed to served 3 non-ambulatory adults within the age range of 18 through 59 years old. The home is located in a residential area and consist of 3 client bedrooms, 2 bathrooms, kitchen, dining room, living room, office room, laundry area / closet, and attached garage. The front and backyard are well maintained and there are no pools or large bodies of water. There is a shaded seating area for the clients located in the backyard. The home has a sprinkler system and operating delayed egress. There are currently 3 clients residing at the facility.
Client bedrooms were checked. Each bedroom is equipped with the proper furnishings. Bedrooms also have sufficient closet space. The bathrooms were toured. Bathrooms are clean and have the required hygiene items. The water temperature was tested in both bathrooms and measured at 113.4 in bathroom #1 and 115.1F in bathroom #2 which is within the required 105 - 120 degrees. The kitchen was inspected. There is sufficient perishable and non-perishable food. All the appliances are clean and working properly. Sharps are locked in a medication closet and are inaccessible to clients. The fire extinguishers observed to be fully charged. Smoke/carbon monoxide detectors were observed to be fully operational. LPA observed laundry detergent, cleaning solutions/disinfectants are stored and locked in the garage and in the laundry area. All clients medications were reviewed. Medications are centrally stored in cabinet / closet located in the hallway. Medications are documented properly and given as prescribed. The first aid kit was observed and found to be in compliance with the Title 22 Regulations. LPA reviewed client files to confirm emergency contacts have been updated. LPA confirmed staff working have fingerprint clearances. Last emergency/ fire drill was conducted on 05/06/24.

No deficiency was observed during today's visit. Exit interview was conducted with Roger Escorcia and a copy of report was provided.

SUPERVISORS NAME: Wei Siew Ho
LICENSING EVALUATOR NAME: Nune Margaryan
LICENSING EVALUATOR SIGNATURE: DATE: 07/16/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/16/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 1