<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198603301
Report Date: 08/26/2022
Date Signed: 08/26/2022 02:18:31 PM

Document Has Been Signed on 08/26/2022 02:18 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:LAGUARDIA HOMEFACILITY NUMBER:
198603301
ADMINISTRATOR:CORONADO, TOMASAFACILITY TYPE:
735
ADDRESS:18615 LAGUARDIA STTELEPHONE:
(626) 581-1384
CITY:ROWLAND HEIGHTSSTATE: CAZIP CODE:
91748
CAPACITY: 4CENSUS: 4DATE:
08/26/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:45 PM
MET WITH:Tomasa Coronado (Administrator)TIME COMPLETED:
02:30 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
Licensing Program Analyst (LPA) Kruz Long conducted a site visit for the annual inspection. LPA met with Tomasa Coronado (Administrator) and explained the purpose of the visit. The facility is licensed to serve four Developmentally Disabled Clients, age range 18 through 59 years. 2 Ambulatory and 2 Non-Ambulatory.

The facility is located in a residential area. A tour of the single-story facility includes: Living room, kitchen, dining area, den, attached garage/laundry, 3 client bedrooms and 2 bathrooms. The bathrooms are clean and operational. Clients bedrooms were checked and closet/drawer space to accommodate each Client comfortably was available. The hot water temperature was tested and measured within Title 22 Regulation guidelines. The kitchen was observed for the ability to prepare and serve food. LPA observed an appropriate food supply of two days of perishables and seven days of non-perishables. All storage areas for cleaning solutions, toxins, knives, and hazardous items are secured and inaccessible to Clients. Hygiene products are readily available. The last Fire/Emergency Drill was conducted on 08/04/2022. The Administrator's certificate is current. Smoke detectors and carbon monoxide detector are operable and in compliance. The fire extinguisher was observed in the kitchen and fully charged. The first-aid kit is fully stocked with First-aid Manual. A shaded area with chairs is provided in the back yard. The backyard is free of debris/hazards and the outdoor and passageways are free of obstruction. The outdoor activity area is free of hazards and debris and the trash cans have covered lids. Sufficient staff as necessary to ensure provision of care and supervision to meet client needs were observed. All staff have a criminal record clearance and current First aid/CPR. There are no firearms or bodies of water on the premises. All medications are labeled and maintained in compliance with label instructions and State and Federal law. All medications for Clients are kept locked and inaccessible to other Clients.

No deficiencies were observed during today's visit.
An exit interview was conducted and a copy of this report was provided to the Tomasa Coronado.
SUPERVISORS NAME: Fernando Fierros
LICENSING EVALUATOR NAME: Kruz Long
LICENSING EVALUATOR SIGNATURE: DATE: 08/26/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/26/2022
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 1