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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198603387
Report Date: 02/27/2024
Date Signed: 02/27/2024 10:30:28 AM

Document Has Been Signed on 02/27/2024 10:30 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
GREATER LA AC/SC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754
FACILITY NAME:JMJ CAREFACILITY NUMBER:
198603387
ADMINISTRATOR:KIM, MOO JUNGFACILITY TYPE:
735
ADDRESS:1346 BALLISTA AVETELEPHONE:
(805) 259-6715
CITY:LA PUENTESTATE: CAZIP CODE:
91744
CAPACITY: 4CENSUS: 0DATE:
02/27/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:06 AM
MET WITH:Jungea Chun, AdministratorTIME COMPLETED:
10:45 AM
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Licensing Program Analyst (LPA) Cynthia Chan conducted an unannounced annual inspection. LPA met with administrator, Jungea Chun and explained the reason for the visit. The facility is licensed for 4 adults, ages 18 through 59, of which 2 may be non-ambulatory. Rooms #2 and #3 are approved for non-ambulatory. There is currently no client residing at the home.

The facility is a one story house consisting of 4 client bedrooms, 2 bathrooms, living room, dining area, kitchen, office area, and detached garage. The laundry area is located outside in the backyard. The spacious back yard is well maintained and has a shaded area and sitting area for client to use. There are no pool or bodies of water on the premises. Each clients bedroom has the required furniture, lighting, and closet space. Knives and cleaning products are locked in the kitchen cabinets. Smoke and carbon monoxide combo detectors are located in each room. The hot water temperature was measured between the required range of 105-120 degrees F. The food supply is adequate. There is a centrally stored medication cabinet located in the kitchen area. However, no medications were reviewed since there are no clients. Staff and Client files will be stored at the facility. LPA requested to email the updated Emergency Disaster Plan LIC610D for review.

No deficiencies were issued. However, LPA provided technical advisories.
An exit interview was conducted and a copy of the report was given to the administrator.
SUPERVISORS NAME: Tony Vasallo
LICENSING EVALUATOR NAME: Cynthia D Chan
LICENSING EVALUATOR SIGNATURE: DATE: 02/27/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/27/2024
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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