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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198603394
Report Date: 02/23/2024
Date Signed: 02/27/2024 07:54:13 AM

Document Has Been Signed on 02/27/2024 07:54 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: 3DATE:
02/23/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
02:35 PM
MET WITH:Ivy PinedaTIME COMPLETED:
03:50 PM
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Licensing Program Analyst (LPA) Angelica Rea conducted an annual/required visit. LPA met with Direct Care Staff, Ivy Pineda and explained the reason for the visit. Ms. Pineda assisted with today's visit.

LPA Rea and Ms. Pineda toured the facility inside and out, reviewed food supply, reviewed resident medications, and reviewed client and staff files. Passageways are clear and free of obstructions. The front and backyard are well maintained. There are no pools or large bodies of water. Cleaning supplies, toxins, and sharp objects are inaccessible to clients. Facility maintains a comfortable temperature. There is sufficient lighting throughout the facility including bedrooms and common areas. The client bedrooms have the required furniture such as bed frames, dresser drawers, lamps and lift systems. There is sufficient closet space for each client. The client bathrooms were observed to be clean during the visit and had the required equipment to meet the clients needs. The hot water temperature was tested and measured between 105 -120 degrees, which is within the required range. The smoke detectors/carbon monoxide detectors were tested during the visit and were operating properly. The last disaster drill was conducted on 02/1/2024.

Per California Code of Regulations, Title 22, and California Health and Safety Code, there were no deficiencies observed during the visit.

Exit interview was conducted and a copy of report provided to Ms. Pineda.
SUPERVISORS NAME: Lisa Hicks
LICENSING EVALUATOR NAME: Angelica Rea
LICENSING EVALUATOR SIGNATURE: DATE: 02/23/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/23/2024
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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