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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198603349
Report Date: 10/09/2023
Date Signed: 10/09/2023 11:48:57 AM

Document Has Been Signed on 10/09/2023 11:48 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:EDWARD'S COVEFACILITY NUMBER:
198603349
ADMINISTRATOR:CRUZ, EDWARD E.FACILITY TYPE:
735
ADDRESS:11954 166TH STREETTELEPHONE:
(714) 659-9152
CITY:ARTESIASTATE: CAZIP CODE:
90701
CAPACITY: 3CENSUS: 0DATE:
10/09/2023
TYPE OF VISIT:Case Management - Annual ContinuationUNANNOUNCEDTIME BEGAN:
08:48 AM
MET WITH:Administrator Edward CruzTIME COMPLETED:
12:01 PM
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On 10/09/23 at 8:48 a.m., Licensing Program Analyst (LPA) Jewel Baptiste conducted an unannounced Annual continuation inspection to Edwards Cove. Upon arrival LPA was greeted by the Administrator Edward Cruz and explained the reason for the visit. This home is licensed to serve age range 18 through 59. Approve for (3) Ambulatory only. The facility does not have any clients at this time. The Administrator Certificate expired on 6/05/2023 #6044600735. LPA observed on the CCLD website the facility’s administrator certificate is pending. During today's visit LPA inspected the physical plant inside and outside, reviewed the food supply, tested the smoke/carbon monoxide detectors, reviewed (2) staff files.

This home contains 2 bedrooms, 1 office/staff room, 1 meeting/visitors area, 2 bathrooms, living room, linen room, kitchen, and dining room. The home also has a caregiver’s quarters in the back yard which contains 2 rooms. LPA toured the physical plant with the Administrator and observed all client bedrooms contained required furniture, lamps, dresser, chair, and closet space. The rooms also contain personal belongings of the licensee. The two bathrooms contain a working toilet, basin and water faucet, shower with grab bar. The temperature measured at 124.1*F-127.0*F respectively which does not meet title 22 guidelines. This poses a potential safety hazard to the clients. The smoke detectors were battery operated and individually tested and observed to be working properly. The carbon monoxide detector was located throughout the facility, tested, and functioning properly. There were (2) fire extinguishers located in kitchen and office fully charged and up to date. The kitchen was toured and contained working appliances; refrigerator, stove, oven and contained dishware, cups, plates, utensils, pots, and pans with. Toxins and medications were not fully secured. The pantry was stocked with canned goods, pasta, cereals, and the food supply contained a sufficient supply with a two-day supply of perishables and a seven-day supply of non-perishables that met title 22 guidelines. LPA observed debris around the Kitchen, bathrooms, and meeting/visitors’ area. (Report continued on LIC809C.)
SUPERVISORS NAME: Lisa Hicks
LICENSING EVALUATOR NAME: Jewel Baptiste
LICENSING EVALUATOR SIGNATURE: DATE: 10/09/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/09/2023
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: EDWARD'S COVE
FACILITY NUMBER: 198603349
VISIT DATE: 10/09/2023
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The outdoor grounds were toured and inspected, and the patio contain debris and needed a more comfortable shaded area for the clients.

The following Technical Advisory and Violations was issued. LPA discussed another inspection prior to admitting new clients. Exit interview conducted with Edward Cruz, Administrator, a copy of this report was provided.
SUPERVISORS NAME: Lisa Hicks
LICENSING EVALUATOR NAME: Jewel Baptiste
LICENSING EVALUATOR SIGNATURE:

DATE: 10/09/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/09/2023
LIC809 (FAS) - (06/04)
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