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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198603237
Report Date: 12/02/2021
Date Signed: 12/02/2021 02:22:03 PM

Document Has Been Signed on 12/02/2021 02:22 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:NURTURE HOME CAREFACILITY NUMBER:
198603237
ADMINISTRATOR:TORRES, PRINCESS WILYNFACILITY TYPE:
735
ADDRESS:13651 BARLIN AVENUETELEPHONE:
(424) 362-6566
CITY:DOWNEYSTATE: CAZIP CODE:
90242
CAPACITY: 6CENSUS: 3DATE:
12/02/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:30 AM
MET WITH:Reysnonvon Santos/Vanessakay Batara- managerTIME COMPLETED:
02:40 PM
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12/2/2021 at 11:30 a.m. Licensing Program Analyst (LPA) Nina Galarza conducted an unannounced annual inspection visit. LPA met with facility staff member, Reysnonvon Santos and stated the purpose of the visit. LPA later met with manager, Vanessakay Batara and stated the purpose of the visit. LPA conducted annual visit using the infection control domain tool.

The facility is a one story residential home with (4) client bedrooms, (1) client bathroom and (1) staff bathroom and is licensed for 6 non-ambulatory Developmentally Disabled clients between the ages of 18 and 59 years old, serviced by South Central Los Angeles Regional Center.

At 12:00 p.m. LPA Galarza toured the physical plant with facility staff member, Reysnonvon Santos. LPA toured facility property, including but not limited to the dining room, living room, kitchen, client bedrooms, client bathroom, staff bathroom, laundry room, garage and outside areas of the facility to ensure compliance with Title 22 regulations. The facility has one central entry point and has implemented screening and sign in procedures at the front of the home. LPA observed the facility to have hand washing, COVID - 19 informational, and social distancing signs posted throughout the facility. The facility has a designated infection control lead. The facility is able to designate a dedicated a Covid-19 wing if needed. Common touch surfaces are cleaned after each use. All staff were observed to be wearing mask upon entrance and during visit. Client and staff bathrooms were observed to be clean, operational and equipped with grab bars and non-skid mats. The hot water temperature was tested in client bathroom and was observed to be at 112.6 degrees Fahrenheit.The kitchen was inspected. LPA observed the kitchen equipment to be clean and in working condition. LPA observed the food supply stored at the facility. 2 day perishable and 7 days of non-perishable food for all clients was observed. Cleaning chemicals, and knives are locked and inaccessible to clients.

CONTINUED 809-C
SUPERVISORS NAME: Wei Siew Ho
LICENSING EVALUATOR NAME: Nina Galarza
LICENSING EVALUATOR SIGNATURE: DATE: 12/02/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/02/2021
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 2
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: NURTURE HOME CARE
FACILITY NUMBER: 198603237
VISIT DATE: 12/02/2021
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LPA observed the centrally stored medications area to be locked and inaccessible to clients. LPAs reviewed client medications records and stored medication. All medications were properly labeled and administered as directed by the physician.

The fire extinguisher was observed to be fully charged. Smoke/carbon monoxide detectors were observed to be fully operational.

An outdoor shaded area is available in the backyard. There was no pool or bodies of standing water observed in the exterior of the facility property. Exits and passageways were free of obstructions.

Per the California Code of Regulations, Title 22 no deficiencies observed. Exit interview held, copy of report and appeal rights provided.

SUPERVISORS NAME: Wei Siew Ho
LICENSING EVALUATOR NAME: Nina Galarza
LICENSING EVALUATOR SIGNATURE:

DATE: 12/02/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/02/2021
LIC809 (FAS) - (06/04)
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