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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198603327
Report Date: 10/12/2023
Date Signed: 10/12/2023 03:32:04 PM

Document Has Been Signed on 10/12/2023 03:32 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: 1DATE:
10/12/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:20 PM
MET WITH:TIME COMPLETED:
03:35 PM
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Licensing Program Analyst (LPA) V. Maldonado made an unannounced visit at the facility for the purpose of conducting the required annual inspection, using the Compliance and Regulatory Enforcement (CARE) Tool, to evaluate the facility. LPA Maldonado met with Licensee/Administrator, Richard Risinger, and explained the purpose for the visit.

During today's visit, LPA Maldonado conducted a tour of the physical plant with Licensee, observed the facility food supplies, reviewed client medications, client and staff files, and conducted interviews with Staff# 1-2 (S1-S2) and Client# 1 (C1). There is currently only (1) client residing at the facility. The facility is a single-story home, operating as an Adult Residential Facility, licensed to serve (6) adults, ages 18-59. It has an approved fire clearance to serve (6) non-ambulatory clients, of which (1) may be bedridden in bedroom# 5, only. The home consists of a kitchen, dining room, living room, (4) client bedrooms, (1) office, (4.5) bathrooms, laundry area, indoor/outdoor activity space, attached garage, and a shaded patio with seating.

All client bedrooms were inspected and had the required furniture, adequate storage space, and sufficient lighting. Bathrooms were equipped with a toilet, wash basin, and showers and had the required grab bars and non-skid material. The water was tested and measured between 116*F-117*F, which is in compliance. The food supplies was observed and facility had the required 2-day perishables and 7-day non-perishables, as well as emergency food and water supplies available. Fire extinguishers were observed throughout, with current inspections and were fully charged. The home was in good repair and walkways were observed to be free of debris and obstructions/hazards. All toxins, cleaning supplies, and sharps/knives were observed stored under the kitchen sink and in a cabinet next to the cleaning supplies, locked and inaccessible to clients. Laundry equipment was observed in good repair and operational during the visit.

(Report Continued on LIC809-C...)
SUPERVISORS NAME: Fernando Fierros
LICENSING EVALUATOR NAME: Valeria Maldonado
LICENSING EVALUATOR SIGNATURE: DATE: 10/03/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/03/2023
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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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: 10/12/2023
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There were sufficient linens, towels, and personal hygiene supplies available. The facility has an approved mitigation plan on file and a current infection control plan submitted to the department. Sufficient PPE supplies were observed stored in the garage. Smoke/carbon monoxide detectors were observed in each room of the home. (3) staff files and (1) client file were reviewed for required documentation, including but not limited to: training/certification, health screenings, admission records, and appraisals. Files were observed to be complete. (1) client's medications were reviewed and observed to be documented properly and given as prescribed.

During today's visit, no deficiencies were observed or cited.

An exit interview conducted with Licensee and a copy of the report was provided.
SUPERVISORS NAME: Fernando Fierros
LICENSING EVALUATOR NAME: Valeria Maldonado
LICENSING EVALUATOR SIGNATURE:

DATE: 10/12/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/12/2023
LIC809 (FAS) - (06/04)
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