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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198603237
Report Date: 12/09/2022
Date Signed: 12/09/2022 02:35:27 PM

Document Has Been Signed on 12/09/2022 02:35 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: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: 4DATE:
12/09/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:41 AM
MET WITH:Princess Torres - AdministratorTIME COMPLETED:
02:50 PM
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Licensing Program Analyst (LPA) Luis Mora conducted an unannounced annual visit at the facility with focus on the infection control domain, medication and food review. LPA Mora met with Gherineire Armas (Direct Support Professional) and explained the reason for the visit. The Administrator Princess Torres showed up shortly after. The facility is licensed to serve 6 non-ambulatory clients ages 18-59. The facility is operating within the scope of its license.

A tour of the single-story facility included the 4 client bedrooms, 1 client bathroom, 1 staff bathroom, kitchen, dining area, living room, laundry area, front yard and backyard.

LPA Mora conducted the tour with Gherineire and observed the following: sufficient food supplies for at least 2 days of perishables and 7 days of non-perishables were observed in the kitchen. Sharps are kept locked in a kitchen cabinet. Cleaning chemicals are kept locked under the kitchen sink. The First Aid kit is kept locked in the medication cabinet and it is fully stocked with all required items including a current manual. Medications are kept locked in a dining area cabinet. Client and staff files are kept in the medication cabinet. Clean towels and extra clean linen were observed in a hallway cabinet. Dining and living room have sufficient lighting and sitting area. All bedrooms have all required furniture, lighting, and bedding. The bathrooms were observed with shower mats and grab bars for non-ambulatory clients. The water temperature was tested in the both bathrooms and measured at 112.5 degrees F and 112.7 degrees F, which is within the required 105-120 degrees F. Fire extinguisher were observed in the kitchen and hallway, and are fully charged. Smoke detectors were observed throughout the facility and in each room and were operable during the visit. The carbon monoxide was operable during the visit. The front yard and backyard are clean. There is a shaded area with seating in the backyard. No bodies of water were observed at the facility. Passageways and exits are free of obstruction. Medications for all 4 clients was reviewed. Medications are documented properly and given as prescribed. Files for all 4 clients and 5 staff were reviewed. No deficiencies found with the files.
(CONTINUED TO LIC 809C)
SUPERVISORS NAME: Wei Siew Ho
LICENSING EVALUATOR NAME: Luis Mora
LICENSING EVALUATOR SIGNATURE: DATE: 12/09/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/09/2022
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
GREATER LA AC/SC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754
FACILITY NAME: NURTURE HOME CARE
FACILITY NUMBER: 198603237
VISIT DATE: 12/09/2022
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Facility has 30 days supplies of Personal Protective Equipment in a dining area cabinet. Facility is following COVID-19 recommendations regarding screening visitors, staff, and clients. Covid-19 prevention signs are posted throughout the facility and hand-washing signs were observed in the bathrooms. Sufficient hand soap, hand sanitizer, and paper towels were observed.

Per California Code of Regulations, Title 22, and California Health and Safety Code, there was no deficiencies observed during the visit. Exit interview held and a copy of the report was provided.

SUPERVISORS NAME: Wei Siew Ho
LICENSING EVALUATOR NAME: Luis Mora
LICENSING EVALUATOR SIGNATURE:

DATE: 12/09/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/09/2022
LIC809 (FAS) - (06/04)
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