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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198603436
Report Date: 06/27/2022
Date Signed: 06/27/2022 01:08:54 PM

Document Has Been Signed on 06/27/2022 01:08 PM - 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:HIGHPOINTE CARE - FRENCH LANEFACILITY NUMBER:
198603436
ADMINISTRATOR:STEWART, REUBENFACILITY TYPE:
735
ADDRESS:430 FRENCH LN.TELEPHONE:
(562) 682-0946
CITY:POMONASTATE: CAZIP CODE:
91767
CAPACITY: 4CENSUS: 3DATE:
06/27/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:00 PM
MET WITH:S-1TIME COMPLETED:
01:30 PM
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Licensing Program Analyst (LPA) Elizabeth Irra conducted an unannounced Required-1 year visit focusing on COVID-19 Infection Control Practices. LPA met with S-1 and discussed the purpose of today's visit.

This facility consists of (4) bedrooms, (2) bathrooms, living room, kitchen, dinning room, laundry room and an attached garage. All clients residing at this facility receive case management services provided by San Gabriel Pomona Regional Center.

The following were observed/inspected: .
  • COVID-19 Infection Control Practices (including signs) were observed at the entrance of this facility and the dinning area.
  • Signs are posted to promote hand washing, cough/sneeze etiquette, and physical distancing were observed.
  • PPE supplies observed. Additional PPE supply observed inside the locked medication closet and inside the attached garage.
  • Bathrooms have hand soap and paper towels. Hand washing signs will be posted.
  • Sufficient supply of perishable for 2 days and non-perishable foods for 7 days were observed.
  • Emergency supply backpacks were also observed inside the attached garage.
  • Medication reviewed for (1) Client #1 (C-1). C-2 and C-3 do not take medication.
  • Staff responsible for direct care and supervision will wear masks.

LPA discussed the infection control plan and reminded S-1 of due date of 06/30/2022.

Exit interview conducted, a copy of this report and Appeal Rights were provided to S-1.
SUPERVISORS NAME: Christine Yee
LICENSING EVALUATOR NAME: Elizabeth Irra
LICENSING EVALUATOR SIGNATURE: DATE: 06/27/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/27/2022
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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