<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198603394
Report Date: 03/01/2022
Date Signed: 03/02/2022 11:44:46 AM

Document Has Been Signed on 03/02/2022 11:44 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:GM HOME MEYERFACILITY NUMBER:
198603394
ADMINISTRATOR:MARTINEZ, SUSANFACILITY TYPE:
735
ADDRESS:13118 MEYER ROADTELEPHONE:
(562) 631-4157
CITY:WHITTIERSTATE: CAZIP CODE:
90605
CAPACITY: 4CENSUS: 0DATE:
03/01/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Susan MartinezTIME COMPLETED:
11:15 AM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
Licensing Program Analyst (LPA) Angelica Rea conducted a required annual inspection. LPA Rea was greeted and allowed entry into the facility by Susan Martinez, and Sherry Martinez. There are currently 0 residents living in the facility. Ms. Martinez stated that she plans to admit residents in the next few months.

The physical plant was toured and the following was observed: This facility is located in a residential neighborhood, single story house, with (4) bedroom(s), (3) bathrooms, living room, dining area, and kitchen.

LPA Rea discussed infection control practices with Ms. Martinez. Bedrooms have the required furniture including bedframes, dressers, lamps and chairs. Beds have the required linen and the linen is in good condition. Passageways and exits are free of obstruction. The front and backyard are well maintained. The resident bathrooms are clean, and showers have non-skid materials. The facility temperature at the time the visit was comfortable. There is sufficient lighting throughout the facility. There are smoke detectors located throughout the facility, tested and operational. Carbon monoxide detector was also observed, tested and operational. LPA observed a sufficient supply of PPE in the attached garage.

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 to Ms. Martinez.
SUPERVISORS NAME: Lisa Hicks
LICENSING EVALUATOR NAME: Angelica Rea
LICENSING EVALUATOR SIGNATURE: DATE: 03/01/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/01/2022
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 1