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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198603353
Report Date: 09/29/2021
Date Signed: 09/29/2021 11:01:05 AM

Document Has Been Signed on 09/29/2021 11:01 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:BELSHIRE PARAISOFACILITY NUMBER:
198603353
ADMINISTRATOR:ONG, JOHN CHRISTOPHERFACILITY TYPE:
735
ADDRESS:17807 BELSHIRE AVETELEPHONE:
(562) 402-6422
CITY:ARTESIASTATE: CAZIP CODE:
90701
CAPACITY: 4CENSUS: 0DATE:
09/29/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:40 AM
MET WITH:John Christopher Ong (Administrator)TIME COMPLETED:
11:10 AM
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Licensing Program Analyst (LPA) Kruz Long conducted an unannounced site visit for the annual inspection. Upon arriving, LPA met with John Christopher Ong (Administrator) and explained the purpose of the visit. The facility is licensed to serve age range 18 through 59. Approved for 4 non-ambulatory, of which 2 may be bedridden.

The facility is located in a residential area. A tour of the single-story facility includes: Living room, family room, attached garage/break room, dining area, kitchen, laundry area, four client bedrooms and 2 bathrooms.

During today’s visit, LPA observed the following: There are currently no Clients residing in the facility. Licensee is not operating beyond the conditions and limitations specified on the license, including the capacity. All outdoor and indoor passageways are free of obstruction and a shaded area is provided. There are no pools or large bodies of water on the premises. There are no firearms on the premises and other dangerous weapons such as knives are locked in the laundry room cabinet. Disinfectants, cleaning solutions, poisons are locked in the garage. A comfortable temperature is maintained. Lamps or lights in all rooms to ensure the comfort and safety were observed. Hot water temperature measured at 105.6 degrees F in bathroom #1. All toilets, hand washing and bathing facilities is safe, sanitary and in operating condition. Hygiene products are readily available. Freezers and refrigerators are clean and maintain temperatures. All staff have a criminal record clearance. Staff responsible for direct care and supervision have current first aid. First aid kit/manual in locked in the dining area cabinet. Fire extinguisher mounted to the dining area wall and family room wall are fully charged. Smoke detector/carbon monoxide detectors are operational.

No deficiencies were observed during today's visit.

An exit interview was conducted and a copy of this report was provided to John Christopher Ong.
SUPERVISORS NAME: Fernando Fierros
LICENSING EVALUATOR NAME: Kruz Long
LICENSING EVALUATOR SIGNATURE: DATE: 09/29/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/29/2021
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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