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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198603343
Report Date: 05/06/2024
Date Signed: 05/06/2024 11:47:40 AM

Document Has Been Signed on 05/06/2024 11:47 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
CCLD Regional Office, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754
FACILITY NAME:JFVITACARE1 CORP.FACILITY NUMBER:
198603343
ADMINISTRATOR/
DIRECTOR:		VITANGCOL, FLORENTINOFACILITY TYPE:
735
ADDRESS:211 S. SHIPMAN AVE.TELEPHONE:
(909) 904-0895
CITY:LA PUENTESTATE: CAZIP CODE:
91744
CAPACITY: 6CENSUS: 6DATE:
05/06/2024
TYPE OF VISIT:Case Management - Annual ContinuationUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:00 AM
MET WITH:Administrator Florentino VitangcolTIME VISIT/
INSPECTION COMPLETED:
11:55 AM
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Licensing Program Analyst (LPA) Jose Villalobos conducted the unannounced continued annual Inspection visit using the Compliance And Regulatory Enforcement (CARE) Tool. LPA met with Administrator Florentino Vitangcol and the purpose of the visit was discussed.

Infection Control: LPA observed the facility has sufficient PPE supplies. Infection Control Plan is in place. The plan was collected and reviewed.
Operational Requirements: Facility is operating within its approved clearance.
Staffing: The facility has a sufficient staffing in the facility. Facility is present during the Nightshift.
Personnel Records-Training: Personal records centrally stored. LPA inspected five (5) staff files. All staff are background check cleared and associated with the facility. All the staff files have the required Title 22 documents. The administrators certificate is current.
Client's Right - Information: No client in the facility required any postural support at the present time. Required postings observed.
Food Service: Supply of Non perishables and perishables was observed. Food supply was adequately stored. Pesticides and other toxic substances were not stored with the food supply. Kitchen area was clean.
Client Records/Incident Reports: Client files are centrally stored. LPA reviewed six (6) client files. Client files are up to date and have required documents.
Incidental Medical Services: Currently no clients on restricted health condition plans. There are no clients in care with prohibited health conditions. First Aid kid observed and available when needed.
Disaster preparedness: The facility has an updated emergency disaster plan. Facility conducts fire/disaster drills. Facility has client information readily available in case of emergencies.
Emergency Intervention: The facility are not using any restraints in the facility.

Inspection tool completed. No deficiencies are being cited today. Exit interview conducted and a copy of this report was provided.
SUPERVISORS NAME: Fernando Fierros
LICENSING EVALUATOR NAME: Jose Villalobos
LICENSING EVALUATOR SIGNATURE: DATE: 05/06/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/06/2024
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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