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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198603347
Report Date: 06/21/2022
Date Signed: 06/21/2022 02:10:38 PM

Document Has Been Signed on 06/21/2022 02:10 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:PHILADELPHIAN HOMEFACILITY NUMBER:
198603347
ADMINISTRATOR:RESURRECCION, LEANDROFACILITY TYPE:
735
ADDRESS:5856 PEARCE AVENUETELEPHONE:
(562) 732-7514
CITY:LAKEWOODSTATE: CAZIP CODE:
90712
CAPACITY: 4CENSUS: DATE:
06/21/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:00 PM
MET WITH:Leandro Resurreccion - AdministratorTIME COMPLETED:
02:25 PM
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Licensing Program Analyst (LPA) Luis Mora conducted an unannounced annual visit at the facility with focus on the infection control domain, medication and food review. LPA Mora met with Administrator Leandro Resurreccion and explained the reason for the visit. The facility is licensed to serve 4 ambulatory, of which 2 may be non-ambulatory clients in the age range 18 of through 59. There are currently 4 ambulatory clients serviced by Harbor Regional Center.

The facility is in a residential area and it is a one story family home. A tour of the single-story facility included the living room, dining room, kitchen, office room, 4 client bedrooms, 2 client bathrooms, laundry room, staff room, front yard, backyard, and detached garage.

LPA Mora conducted the tour with Leandro Resurreccion and observed the following: sufficient food supplies for at least 2 days of perishables and 7 days of non-perishables were observed in the kitchen. Sharps were observed locked under the kitchen sink. Chemical and cleaning solutions are kept locked in a kitchen cabinet. The First Aid kit is kept in the medication cabinet and it is fully stocked with all required items including a current manual. Clean towels and extra clean linen were observed in the hallway cabinet. Dining and living room have sufficient lighting and sitting area. Medications are kept locked in an office cabinet. Client and staff files are kept in the office room. All bedrooms have all required furniture, lighting, and bedding. All bathrooms were observed with shower mats. The water temperature was tested in both bathrooms and measured at 110.3 degrees F and 105 degrees F, which is within the required 105-120 degrees F. A fire extinguisher was observed in the kitchen and it is fully charged. Smoke detectors were observed throughout the facility and in each room and were operable during the visit. There are four carbon monoxides located in the kitchen, hallway, laundry area and office room, the front yard and backyard are clean. There is a shaded area with seating in the backyard. No bodies of water were observed at the facility. Passageways and exits are free of obstruction.
(CONTINUED TO LIC 809C)
SUPERVISORS NAME: Stefanie Coronel
LICENSING EVALUATOR NAME: Luis Mora
LICENSING EVALUATOR SIGNATURE: DATE: 06/21/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/21/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 2
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: PHILADELPHIAN HOME
FACILITY NUMBER: 198603347
VISIT DATE: 06/21/2022
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LPA reviewed medication for 3 clients and observed that medications are documented properly and given as prescribed. One of the clients is on vacation with the family and took the medications. LPA reviewed files for all 4 clients and 3 staff. LPA observed administrator certificate for Leandro Resurreccion - 6051402735 with an expiration date of 03/11/2023.

Facility has 30 days supplies of Personal Protective Equipment in the garage. Facility is following COVID-19 recommendations regarding screening visitors, staff, and clients. Covid-19 prevention signs are posted throughout the facility and hand-washing signs were observed in the bathrooms. Sufficient hand soap, hand sanitizer, and paper towels were observed.

Per California Code of Regulations, Title 22, and California Health and Safety Code, there were no deficiencies observed during the visit. Exit interview held and a copy of the report was provided.

SUPERVISORS NAME: Stefanie Coronel
LICENSING EVALUATOR NAME: Luis Mora
LICENSING EVALUATOR SIGNATURE:

DATE: 06/21/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/21/2022
LIC809 (FAS) - (06/04)
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