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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198603251
Report Date: 11/10/2022
Date Signed: 11/10/2022 09:51:40 AM

Document Has Been Signed on 11/10/2022 09:51 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:
11/10/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
08:13 AM
MET WITH:Kevin Van Beek TIME COMPLETED:
10:13 AM
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Licensing Program Analyst (LPA) Christine Wong conducted an unannounced annual required visit. LPA met with DSP Vicente Ciruela and explained the reason for the visit. LPA used the infection control tool to evaluate the facility. LPA observed the facility plant, COVID-19 procedures, reviewed clients' medications, observed food supply, and reviewed clients and staff files. Shortly after, the administrator Kevin Van Beek arrived and assisted with the visit.

The facility is single story house and located in a residential neighborhood. The facility includes kitchen, dining area, living room, four clients bedrooms, two bathrooms and computer/medication area and a attached garage. All 4 clients bedrooms were toured. Bedroom#1 and #2 has two beds, two night stands, two drawers and required bed linen and furniture and sufficient closet space and lighting. Bedroom#3 and #4 has one bed, one chair, one night stand, required bed linen and sufficient closet space and lighting. All 2 bathrooms were toured. They are clean, sanitary and in a working condition. The hot water in two bathrooms were tested at 120 degrees F which is within Title 22 regulation. The refrigerator in the kitchen, pantry and garage has sufficient 2 days perishable and 7 days non perishable food supply. All the appliances are clean and working properly. The sharp utensils and knives were stored and locked in a kitchen cabinet. The common areas such as living room and dining area are clean and have the required furniture. The back yard has a shaded area and sitting area for client to utilize. LPA also inspected the smoke detectors and carbon monoxide detectors and they are interconnected and working properly.

LPA reviewed all 6 clients files and their emergency contact information is updated. LPA also reviewed 2 staff files to confirm health screenings and fingerprint clearances and they are all updated in their personnel files. LPA reviewed all 6 clients medication and they are all centrally stored and the medications are seemed accurate and updated.

SUPERVISORS NAME: Christine Yee
LICENSING EVALUATOR NAME: Christine Wong
LICENSING EVALUATOR SIGNATURE: DATE: 11/10/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/10/2022
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
CCLD Regional Office, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754
FACILITY NAME: VB CARE HOMES
FACILITY NUMBER: 198603251
VISIT DATE: 11/10/2022
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Facility is currently following COVID 19 recommendations regarding COVID 19 signs throughout the facility, and facility is disinfected three times a day , the bathrooms have sufficient soap, paper towels, and signs, PPE supplies are sufficient for more than 30 days.

No deficiencies observed during the visit

Exit Interview conducted. A copy of the report was provided to Administrator Kevin Van Beek.

SUPERVISORS NAME: Christine Yee
LICENSING EVALUATOR NAME: Christine Wong
LICENSING EVALUATOR SIGNATURE:

DATE: 11/10/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/10/2022
LIC809 (FAS) - (06/04)
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