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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198603302
Report Date: 01/31/2025
Date Signed: 01/31/2025 05:50:41 PM

Document Has Been Signed on 01/31/2025 05:50 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
GREATER LA AC/SC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754
FACILITY NAME:SUMMIT VIEW HOME CAREFACILITY NUMBER:
198603302
ADMINISTRATOR/
DIRECTOR:
CASTRO, SILVIAFACILITY TYPE:
740
ADDRESS:107 CLEARVIEW CREST DRTELEPHONE:
(909) 396-7839
CITY:DIAMOND BARSTATE: CAZIP CODE:
91765
CAPACITY: 6TOTAL ENROLLED CHILDREN: 0CENSUS: 6DATE:
01/31/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
02:38 PM
MET WITH:Theresa Kuwashima, StaffTIME VISIT/
INSPECTION COMPLETED:
04:40 PM
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Licensing Program Analyst (LPA) Cynthia Chan conducted the unannounced annual inspection. LPA met with Staff, Theresa Kuwashima. Administrator, Silvia Castro, arrived shortly after to assist with the visit. The facility is licensed for 6 non-ambulatory residents, ages 60 and over, of which 1 may be bedridden. There is a hospice waiver approved for 3 residents.

LPA utilized the Compliance and Regulatory Enforcement (CARE) tool to inspect the facility.
Infection Control: The facility staff are continuing to follow their infection control and performing proper hand hygiene to assist residents. Staff are cleaning and disinfecting daily. The Administrator reviews the Infection Control plan annually and provides the training to staff.
Operational Requirements: The facility has a dementia care plan to accept or retain residents with dementia. There are currently 5 non-ambulatory and 1 ambulatory residents residing at the facility. There are no residents with a prohibited or restricted health condition. The facility has the sufficient liability insurance to cover injury to residents and guests.
Physical Plant & Environment Safety: The one-story home consists of 4 resident bedrooms, 1 communal bathroom, 1 staff room with private bathroom, living room, kitchen, dining area, laundry area, and attached garage. The smoke detectors are hard-wired and 1 carbon monoxide detector in the hallway by the front door. The fireplace is adequately screened. There are no pools or bodies of water on the premises and no items obstructing the walkway. Cleaning supplies are locked in the closet and inaccessible to residents. Knives and sharps are locked.
Food Service: Sufficient food supplies of perishable and non-perishable are observed. Extra foods are stored in the garage refrigerator.
Disaster Preparedness: The facility has an Emergency Disaster Plan posted with contact numbers and at least 2 relocation sites. Disaster drills are conducted quarterly with staff and residents.

LPA will return another day to inspect the remainder of the domains. No deficiencies were issued today. An exit interview was held and a copy of this report was given to the administrator.
Tony VasalloTELEPHONE: (323) 981-3977
Cynthia D ChanTELEPHONE: (323) 981-3370
DATE: 01/31/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/31/2025
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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