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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198603251
Report Date: 12/10/2021
Date Signed: 12/10/2021 10:46:31 AM

Document Has Been Signed on 12/10/2021 10:46 AM - 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:VB CARE HOMESFACILITY NUMBER:
198603251
ADMINISTRATOR:BEVINAHALLI SURESHFACILITY TYPE:
735
ADDRESS:18412 DEL BONITATELEPHONE:
(714) 393-6361
CITY:ROWLAND HEIGHTSSTATE: CAZIP CODE:
91748
CAPACITY: 6CENSUS: 6DATE:
12/10/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:25 AM
MET WITH:Kevin Van Beek (Administrator)TIME COMPLETED:
11:00 AM
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Licensing Program Analyst (LPA) Kruz Long conducted a site visit for the annual inspection. Upon arriving at the facility LPA met with Kevin Van Beek (Administrator) and explained the purpose of the visit. The facility is licensed to serve age range 18 through 59. Two (2) ambulatory and four (4) non-ambulatory.

The facility is located in a residential area. A tour of the single-story facility includes: Living room, kitchen, dining area, attached garage/storage/laundry area, 4 client bedrooms and 2 bathrooms.

During today’s visit, LPA observed the following: Licensee is not operating beyond the conditions and limitations specified on the license, including the capacity. All clients are protected against hazards. All outdoor and indoor passageways are free of obstruction. There are no pools or large bodies of water on the premises. There are no firearms on the premises and other dangerous weapons such as knives are locked in the kitchen cabinet. Disinfectants, cleaning solutions, poisons are inaccessible to clients. A comfortable temperature for clients is maintained. Furnishings, lamps or lights in all rooms to ensure the comfort and safety were observed. Hot water temperature 109.4 degrees F in bathroom #1. All toilets, hand washing and bathing facilities is safe, sanitary and in operating condition. Hygiene products are readily available. All foods are selected, stored, prepared and served in a safe and healthful manner. Nonperishable foods for a minimum of one week and fresh perishable foods for a minimum of two days were observed. Freezers and refrigerators are clean, and maintain temperatures. Smoke detectors and Carbon Monoxide detector are operable. Fire extinguisher in the kitchen is fully charged. Sufficient staff as necessary to ensure provision of care and supervision to meet client needs were observed. Staff have a criminal record clearance. Staff responsible for direct care and supervision have current first aid. The administrator is on the premises a sufficient number of hours necessary to adequately administer the facility in compliance with applicable law and regulation. All medications are labeled and maintained in compliance with label instructions and State and Federal law. Medications are safe, locked and inaccessible. Shaded area and outdoor furniture is available.

No deficiencies were observed during today's visit.
An exit interview was conducted with Kevin Van Beek and a copy of this report was provided.
SUPERVISORS NAME: Fernando Fierros
LICENSING EVALUATOR NAME: Kruz Long
LICENSING EVALUATOR SIGNATURE: DATE: 12/10/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/10/2021
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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