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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198603327
Report Date: 02/24/2023
Date Signed: 02/24/2023 11:37:14 AM

Document Has Been Signed on 02/24/2023 11:37 AM - 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:R PLACE DUARTEFACILITY NUMBER:
198603327
ADMINISTRATOR:RISINGER, ROBERTFACILITY TYPE:
735
ADDRESS:3002 FREEBORN STREETTELEPHONE:
(626) 609-7159
CITY:DUARTESTATE: CAZIP CODE:
91010
CAPACITY: 6CENSUS: 1DATE:
02/24/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Robert Risinger, Administrator TIME COMPLETED:
11:45 AM
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Licensing Program Analyst (LPA) Cynthia Chan conducted the annual inspection with the focus on the Infection Control Domain. LPA Chan arrived unannounced and met with Administrator Robert Risinger. The facility is licensed for 6 non-ambulatory adults, ages 18 through 59, of which 1 may be bedridden. The bedridden room is located in room #5. There is currently one client residing at the home.

The facility consists of 5 bedrooms, 4 1/2 bathrooms, living room, dining room, kitchen, laundry area, and an attached garage. The backyard has a shaded area for client use. The facility previously submitted a mitigation plan in which they are still following.

The inspection consisted of the following:
  • There is one entry point for visitors. Visitors are screened for COVID-19 symptoms and temperature taken.
  • Hand sanitizers are readily available.
  • COVID-19 signage are posted throughout the home.
  • There are sufficient supplies of 2-day perishable and a week of non-perishable observed.
  • Each client bedroom had the required furniture and well maintained. The bathrooms have paper towels and soap.
  • PPE supplies for at least 30-days are stored in the garage.
  • Sharps, knives, and cleaning solutions are locked.
  • Medications are locked and centrally stored in the kitchen area.
  • Staff was wearing face mask.
  • Emergency Contact information are posted on the bulletin board.

No deficiencies issued today. An exit interview was conducted and a copy of this report was given to the Administrator.
SUPERVISORS NAME: Tony Vasallo
LICENSING EVALUATOR NAME: Cynthia D Chan
LICENSING EVALUATOR SIGNATURE: DATE: 02/24/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/24/2023
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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