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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198603237
Report Date: 11/04/2024
Date Signed: 11/04/2024 04:11:49 PM

Document Has Been Signed on 11/04/2024 04:11 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
MONTEREY PARK ASC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754
FACILITY NAME:NURTURE HOME CAREFACILITY NUMBER:
198603237
ADMINISTRATOR/
DIRECTOR:
TORRES, PRINCESS WILYNFACILITY TYPE:
735
ADDRESS:13651 BARLIN AVENUETELEPHONE:
(424) 362-6566
CITY:DOWNEYSTATE: CAZIP CODE:
90242
CAPACITY: 6CENSUS: 4DATE:
11/04/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:34 PM
MET WITH:Administrator TORRES, PRINCESS WILYNTIME VISIT/
INSPECTION COMPLETED:
04:30 PM
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Licensing Program Analyst (LPA) Tyler Reyes conducted the unannounced Annual Inspection and met with Assistant Administrator Derry Sandajan and explained the reason for today’s visit.

For today's inspection LPA used the Compliance and Regulatory Enforcement (CARE) Tools to inspect the facility. The facility is licensed for 18 through 59 and non-ambulatory. The facility is a single-story with living room, kitchen, laundry room, dining area, (4) client bedrooms, (2) restrooms, attached garage, front and backyard.

LPA conducted the tour with Derry Sandaja 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 and inaccessible to clients in care. Cleaning chemicals are kept locked and kept in room in laundry area. 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 medication was checked for 4 clients and no deficiencies noted. Client files are kept locked in medication cabinet and staff files are on an online portal, all documentation's are present and staff are cleared. 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, there is (2) residents with half bed rails and a physician order is in place. 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 within the required 105-120 degrees F. Fire extinguisher were observed in the kitchen, 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.
(CONTINUATION TO LIC 809-C)
SUPERVISORS NAME: Fernando Fierros
LICENSING EVALUATOR NAME: Tyler Reyes
LICENSING EVALUATOR SIGNATURE: DATE: 11/04/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/04/2024
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
MONTEREY PARK ASC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754
FACILITY NAME: NURTURE HOME CARE
FACILITY NUMBER: 198603237
VISIT DATE: 11/04/2024
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Administrator Adult Residential Facility Certificate for Adrian Torres Expires 05/02/2026

Earthquake and Fire Drill 8/26/24

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 via email.
SUPERVISORS NAME: Fernando Fierros
LICENSING EVALUATOR NAME: Tyler Reyes
LICENSING EVALUATOR SIGNATURE:

DATE: 11/04/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/04/2024
LIC809 (FAS) - (06/04)
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