198603276-9-11-2023-28-AS-JBAE-CVKQLQ-20230911121620

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 198603276
Report Date: 09/11/2023
Date Signed: 09/11/2023 12:16:25 PM

Document Has Been Signed on 09/11/2023 12:16 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
CCLD Regional Office, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754

FACILITY NAME:	YEARLING BOARD AND CARE		FACILITY NUMBER:	198603276
ADMINISTRATOR:	TANGONAN, MARIA ISABEL		FACILITY TYPE:	740
ADDRESS:	11439 YEARLING CIRCLE		TELEPHONE:	(562) 307-7668
CITY:	CERRITOS	STATE: CA	ZIP CODE:	90703
CAPACITY:	6	CENSUS: 6	DATE:	09/11/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	09:00 AM
MET WITH:	Administrator Maria Isabel Tangonan		TIME COMPLETED:	12:30 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	On 9/11/23 at 9:00 a.m., Licensing Program Analyst (LPA) Jewel Baptiste conducted an unannounced Annual/Required inspection to Yearling Board and Care. Upon arrival LPA was greeted by Direct Support Professional (DSP) Jean Andrade who contacted the Administrator, Maria Tangonan. The Administrator arrived at 9:10 a.m., and LPA explained the reason for the visit. This home is licensed to serve age range 60 and over. (6) non-Ambulatory of which (1) may be bedridden. The bedridden resident is approved for bedroom #2. Hospice wavier granted for (2) residents. There were (5) resident in care during the time of this visit, the other (1) resident was hospitalized. The last emergency disaster/fire drill was conducted on 9/05/2023. The Administrator Certificate expires on 10/30/2023 #6054015740. During today's visit LPA inspected the physical plant inside and outside, reviewed the food supply, tested the smoke/carbon monoxide detectors, reviewed (3) staff files, (6) resident files, medications, and medication administration records for (6) residents. This home contains 5 resident bedrooms, 1 staff bedroom, 2 bathrooms, 1 staff bathroom, living room, kitchen, dining room and an attached garage. LPA toured the physical plant with the Administrator. and observed all (5) resident bedrooms, contained required furniture, lamps, dresser, chair, and closet space. The three bathrooms contain a working toilet, basin and water faucet, walk in shower with grab bar, shower chair, and bathmat. The temperature measured at 113.5.7F-117.5F. The smoke detectors were battery operated and individually tested and observed to be working properly. The carbon monoxide detector was located throughout the facility, tested, and functioning properly. There were (3) fire extinguishers located in kitchen, hallway and the garage fully charged and up to date. The kitchen was toured and contained working appliances; refrigerator, stove, oven and contained dishware, cups, plates, utensils, pots, and pans with knives secured and locked in a cabinet. The toxins and cleaning supplies were locked underneath kitchen sink. The pantry was well stocked with canned goods, pasta, cereals, and the food supply contained a sufficient supply with a two-day supply of perishables and a seven-day supply of non-perishables that met title 22 guidelines. Walls and floors, cabinets and counters were clean and sanitary throughout the home. (Report continued on LIC809C.)

SUPERVISOR'S NAME: Lisa Hicks	TELEPHONE: (323) 213-1556
LICENSING EVALUATOR NAME: Jewel Baptiste	TELEPHONE: (323) 400-9594
LICENSING EVALUATOR SIGNATURE:	DATE: 09/11/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/11/2023

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
CCLD Regional Office, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754

FACILITY NAME: YEARLING BOARD AND CARE	FACILITY NUMBER: 198603276
	VISIT DATE: 09/11/2023

NARRATIVE

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The outdoor grounds were toured and inspected, and the patio was well maintained with a shaded seating area accessible for resident use. The garage contained a working washer and dryer, with cabinetry that contained emergency supply kits, bottled water, toiletries, personal care supplies, toxins and cleaning agents stored locked.

The dining room contained bingo, coloring supplies, ring toss and activity supplies available to the residents.

Exit interview conducted with Maria Tangonan, Administrator, a copy of this report was provided.

SUPERVISOR'S NAME: Lisa Hicks	TELEPHONE: (323) 213-1556
LICENSING EVALUATOR NAME: Jewel Baptiste	TELEPHONE: (323) 400-9594
LICENSING EVALUATOR SIGNATURE:	DATE: 09/11/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/11/2023

LIC809 (FAS) - (06/04)

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