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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198603327
Report Date: 09/10/2021
Date Signed: 09/10/2021 03:22:00 PM

Document Has Been Signed on 09/10/2021 03:22 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:R PLACE DUARTEFACILITY NUMBER:
198603327
ADMINISTRATOR:RISINGER, ROBERTFACILITY TYPE:
735
ADDRESS:3002 FREEBORN STREETTELEPHONE:
(626) 609-7159
CITY:DUARTESTATE: CAZIP CODE:
91010
CAPACITY: 6CENSUS: 0DATE:
09/10/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:00 PM
MET WITH:Administrator TIME COMPLETED:
03:30 PM
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On 09/10/21 at 12:00 PM Licensing Program Analysts (LPAs) Nune Margaryan and Nina Galarza arrived at this facility unannounced to conduct an annual inspection visit. LPAs met with Administrator Robert Risinger and explained the purpose of the visit.
The facility is licensed for adults between the ages 18 through 59 years. There are currently zero (0) clients at the facility. Total capacity is six (6) and facility is approved for five (5) non ambulatory and one (1) bedridden clients. The facility has one central entry point and has implemented screening and sign in procedures at the front of the home. LPAs observed the facility to have hand washing, COVID - 19 informational, and social distancing signs posted at the front door and throughout the facility. The facility has a designated infection control lead.
LPAs inspected the physical plant including but not limited to the kitchen, dining room, living room, clients bedrooms, bathrooms, laundry room, and outside areas of the facility to ensure compliance with Title 22 regulations. LPA also conducted using the infection control domain tool.
A tour of the single-story facility includes five (5) bedrooms, four and a half (4 1/2) bathrooms, a living room, dining room, kitchen, laundry room, patio and indoor/outdoor activity areas. Bedrooms 1 and 2 are semi-private rooms, bedrooms 3 and 5 are private rooms and bedroom 4 is being used as an office. LPAs observed a fully equipped living room and dining room. Kitchen had all necessary equipment and supplies to meet the needs of six (6) clients. Appliances in the kitchen were clean and all functional. Sufficient supply of nonperishable foods were observed for six (6) clients. The hot water temperature was tested throughout the facility and measured within Title 22 Regulation guidelines.
Chemicals and cleaning solutions were locked and centrally stored in the kitchen cabinet, located underneath the kitchen sink. The facility smoke alarm system and carbon monoxide detectors are hard wired. The facility is also equipped with a sprinkler system. The fire extinguishers observed to be fully charged.

CONTINUED 809-C
SUPERVISORS NAME: Wei Siew Ho
LICENSING EVALUATOR NAME: Nune Margaryan
LICENSING EVALUATOR SIGNATURE: DATE: 09/10/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/10/2021
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: R PLACE DUARTE
FACILITY NUMBER: 198603327
VISIT DATE: 09/10/2021
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Due to no clients in care at time of visit, medications could not be reviewed. Medications will be centrally stored and locked and not accessible to the clients in a closet near kitchen area.
First Aid kit was observed to have all necessary components. First Aid manual was also observed to be up to date.
LPAs observed the facility has perimeter fencing in the back yard. The outdoor activity area is free of visible hazards and debris and the trash cans have covered lids. LPAs observed a shaded area with patio furniture for the clients. The facility has an attached garage which is locked and inaccessible to clients. LPAs observed chemicals and hazardous items inside the garage.


According to the California Code of Regulations (Title 22, Division 6, Chapter 8), LPAs did not observe any deficiencies at this time. An exit interview was conducted and a copy of the Report was provided to Administrator Robert Risinger.
SUPERVISORS NAME: Wei Siew Ho
LICENSING EVALUATOR NAME: Nune Margaryan
LICENSING EVALUATOR SIGNATURE:

DATE: 09/10/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/10/2021
LIC809 (FAS) - (06/04)
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