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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198603251
Report Date: 11/04/2024
Date Signed: 11/05/2024 08:19:58 AM

Document Has Been Signed on 11/05/2024 08:19 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
MONTEREY PARK ASC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754
FACILITY NAME:VB CARE HOMESFACILITY NUMBER:
198603251
ADMINISTRATOR/
DIRECTOR:		BEVINAHALLI SURESHFACILITY TYPE:
735
ADDRESS:18412 DEL BONITATELEPHONE:
(714) 393-6361
CITY:ROWLAND HEIGHTSSTATE: CAZIP CODE:
91748
CAPACITY: 6CENSUS: 6DATE:
11/04/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:35 AM
MET WITH:Kevin Van Beek, AdministratorTIME VISIT/
INSPECTION COMPLETED:
12:55 PM
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Licensing Program Analyst (LPA) Daniel Konishi conducted the required annual inspection. LPA arrived unannounced and met with S1 who allowed the entry of the facility and explained the reason of the visit. S1 helped with touring the facility. Shortly after, the administrator Kevin Van Beek arrived and assisted with the visit. The facility is licensed for age range 18 through 59. Two (2) ambulatory and four (4) non-ambulatory. The facility is a Level 4G home vendored by San Gabriel Pomona Regional Center. Facility currently has 6 clients.

LPA utilized the Compliance and Regulatory Enforcement (CARE) tools for the visit today and following were observed:

1. Infection Control: The facility staff are using appropriate hand hygiene and wearing gloves while assisting clients. Staff are cleaning and disinfecting at least once a day and more often for high touched surfaces. Facility has sufficient PPE supplies and has an Infection Control Plan in place.

2, Physical Plant: The facility is a single-story house and located at a residential neighborhood area. The facility includes: a kitchen, dining area, living room, family room, four clients bedrooms, two bathrooms and attached garage. Bedroom#1 and #2 has two beds, chairs, drawers, required furniture and bedding and sufficient lighting and closet space. Bedroom#3 and #4 has one bed, one chair, one night stand, one drawer, required furniture and bedding and sufficient closet space and lighting. The four clients bathrooms are clean, sanitary and in a good working condition. The hot water in two bathrooms were tested between 107.6 and 108.2 degrees F which are within the Title 22 regulation. The appliances in the kitchen and living room are all a working well. All the sharp knives are stored and locked in the kitchen cabinet. The chemicals and all cleaning supplies are stored in the locked cabinet in the garage. Fire place is covered, secure and inaccessible to clients. The extra personal hygiene products are stored in the locked cabinet in the garage.
SUPERVISORS NAME: David Sicairos
LICENSING EVALUATOR NAME: Daniel Konishi
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: VB CARE HOMES
FACILITY NUMBER: 198603251
VISIT DATE: 11/04/2024
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The extra linens are stored in the hallway cabinet. LPA inspected the carbon monoxide detector and smoke detectors and they are all working well. Fire extinguishers are fully charged and last inspected on 06/28/2024. The facility has a land-line telephone system. The hallway light would be on during nighttime so client can access to the non-private bathrooms. The passageway, walkway and patio are free of obstruction.

3.Operational Requirement: The facility was cleared for two (2) ambulatory and four (4) non-ambulatory. Currently all clients are ambulatory. The last disaster drill was conducted on 09/25/2024. The clients can attend the community activities if there's an opportunity or chance. The facility does have a shaded patio with table and chairs for client to use as an outdoor activity.



4.Staffing: The facility has a total of thirteen (13) staff in the facility. LPA reviewed the NOC-Shift staff and the staff does have the required the facility planned emergency procedure training. The facility has at least one person on call on the premises.

5.Personnel Record-Training: Five (5) staff files were reviewed for criminal background clearance and training. All five (5) staff are associated with the facility. Personnel records have health/Tuberculosis (TB) screenings, employee rights, certifications, and 1st Aid/CPR training. Facility has per regulation staff training in file. The administrator is Kevin Van Beek and administrator certificate expiration date on 09/18/2026. The administrator has an updated HIV and TB training certificate.

6.Client Right: Currently the facility has no client with postural support. The facility does provide internet service with at least one internet access device for client to use as communication with their family members or day program.

7.Clients Record-Incident Reports: The clients files are stored in the file cabinet next to the dining area. LPA inspected all six (6) clients files and they have all the required documents which include face sheet, admission agreement, functional capabilities assessment, individual program plan, physician report, TB test result, ambulatory status, client rights, and medication list.

8.Food Service: Currently one client is on puree diet and the doctor's note is in client's files. The facility has sufficient 2 days perishable and 7 days non-perishable food supply in the facility. All the food are stored properly.
SUPERVISORS NAME: David Sicairos
LICENSING EVALUATOR NAME: Daniel Konishi
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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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: VB CARE HOMES
FACILITY NUMBER: 198603251
VISIT DATE: 11/04/2024
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LPA observed the Kitchen, food preparation area, and storage areas were observed to be clean and sanitary.

9.Health Related Services: The client's medication is centrally stored in the medication cabinet near the family room. LPA reviewed all six (6) client's medication and they are all seemed accurate and updated. First Aid Kit was reviewed and has required items. The facility also provide transportation for client's medical and dental appointments.

10. Incidental Medical Services: Currently the facility has no client is on restricted health condition plan or the facility is not attained any prohibited health condition client.

11. Disaster Preparedness: The facility has an updated emergency disaster plan dated on 04/01/2024 with relocation sites, shutoff valves, and local emergency contact numbers. The last disaster drill was conducted on 09/25/2024.

12, Emergency Intervention: The facility does not use any restraint on clients.

Per California Code of Regulations, Title 22, and California Health and Safety Code, no deficiencies were observed during the visit. Exit Interview conducted and a copy of the report was provided to Administrator Kevin Van Beek.
SUPERVISORS NAME: David Sicairos
LICENSING EVALUATOR NAME: Daniel Konishi
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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