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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198603325
Report Date: 04/16/2024
Date Signed: 04/16/2024 03:57:03 PM

Document Has Been Signed on 04/16/2024 03:57 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:EMJ HOME CAREFACILITY NUMBER:
198603325
ADMINISTRATOR/
DIRECTOR:
TORRES, MICHAELFACILITY TYPE:
735
ADDRESS:1486 LASSITER DRIVETELEPHONE:
(909) 957-5620
CITY:WALNUTSTATE: CAZIP CODE:
91789
CAPACITY: 5CENSUS: 5DATE:
04/16/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:03 PM
MET WITH:Alana Canlas, House ManagerTIME VISIT/
INSPECTION COMPLETED:
04:00 PM
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Licensing Program Analyst (LPA) Cynthia Chan conducted the required annual inspection using the Compliance and Regulatory Enforcement (CARE) tool. LPA arrived unannounced and met with Staff, Maria Gallardo. House manager, Alana Canlas, arrived shortly after to assist with the visit. The facility is licensed for (5) adults, ages 18 - 59, of which 1 may be non-ambulatory.

LPA toured the facility, reviewed files, and conducted interviews. The following were observed:
The facility does not have any pools or bodies of water on the premises. There are 5 client bedrooms, 3 bathrooms, living room, kitchen, and attached garage. Each client has their own bedroom with appropriate furniture and storage space. There are extra linens and hygiene supplies. Facility has an operable smoke detector in each room and a carbon monoxide detector. Knives, cleaning solutions, and disinfectants are locked. The hot water temperature was measured between the required range of 105-120 degrees F.
The facility is operating within the fire clearance approval. Staff are providing care and supervision to meet the clients' needs and assisting in activities of daily living. Staff are continuing to follow their infection control plan and procedures while handling clients. There are sufficient PPE supplies in storage. LPA observed sufficient food supplies of 2 day perishable and a week of non-perishable items. Foods are properly stored in the refrigerator to avoid contamination.
Per the house manager, there is sufficient staffing to assist the clients. They have one overnight staff awake to supervise clients. Staff are all fingerprint cleared and associated to the facility. LPA reviewed records for 4 staff and 5 Clients. They all have the required documents in their files. Facility staff have CPI training and do not use any manual restraints on clients. Staff have current first aid and CPR training. There is one client with a restricted health plan. Medications are centrally locked and inaccessible to clients. LPA reviewed medications for all 5 clients and are being administered as prescribed. The facility has the updated emergency and disaster plan and conducting disaster drills monthly.
No deficiencies were observed today. An exit interview was held and a copy of this report was given to staff S. Alcala.
SUPERVISORS NAME: Tony Vasallo
LICENSING EVALUATOR NAME: Cynthia D Chan
LICENSING EVALUATOR SIGNATURE: DATE: 04/16/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/16/2024
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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