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

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198603436
Report Date: 06/17/2023
Date Signed: 06/19/2023 01:08:22 PM

Document Has Been Signed on 06/19/2023 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
GREATER LA AC/SC, 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:
06/17/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:14 PM
MET WITH:Staff #2 TIME COMPLETED:
04:30 PM
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) Kimberly Ramirez conducted an unannounced Annual Required Visit on 06/17/2023 at 1:14 pm. LPA was met by Staff #1 (S1) and explained the purpose of the visit. S1 assisted in tour of facility. Staff #2 (S2) arrived shortly after to the facility. There are three (3) level 4I developmentally disabled clients in the home. The facility is licensed for clients 18-59 years old. The facility has a fire clearance approved for four (4) ambulatory. All clients receive services from San Gabriel Pomona Regional Center. LPA requested and obtained a copy of Personnel Report, and Resident Roster.

LPA OBSERVATIONS: Tour began at 1:10 am and was led by S1. The facility is a single-story building located in a residential area with four (2) client bedrooms, two (2) bathrooms, kitchen, dining room, front yard, backyard, and attached garage.

· Front Yard: Was clean and well maintained. No hazards were observed.

· Kitchen: LPA observed kitchen to be clean and appliances appeared to be in working order. LPA observed sufficient 2 days of perishables and 7-day supply on non-perishables. LPA observed knives and sharps located in nearby hallway closet, to be inaccessible to 3 (three) out of 3 (three) clients in care. LPA observed several bottles of cleaning solutions and disinfectants located in the garage to be inaccessible to 3 (three) out of 3 (three) clients in care.

· Dining Room/Living room: Dining room was observed to be clean and contained one table with plenty of seating. Living room was observed plenty of seating and lighting.

· Linen Closet: Contained plenty linens, towels, and hygiene products.

· Client Rooms 1 - 4: All contained the required furnishings, lighting and linens. Bedrooms were observed to be clean with plenty of closet space. All bedrooms are currently private.

SUPERVISORS NAME: Tony Vasallo
LICENSING EVALUATOR NAME: Kimberly Ramirez
LICENSING EVALUATOR SIGNATURE: DATE: 06/17/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/17/2023
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 2
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		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: HIGHPOINTE CARE - FRENCH LANE
FACILITY NUMBER: 198603436
VISIT DATE: 06/17/2023
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
26
27
28
29
30
31
32
· Bathrooms: Shared client bathroom# 1 was observed to be clean and contained soap and paper towels. Signs promoting hand washing were observed. Water temperature in this bathroom was measured at 107.6 degrees F which is in the required 105 – 120 degrees F. Bathroom #2 was observed to be clean and water temperature was measured at 106.1 degrees F which is in the required 105 – 120 degrees F.

· Centrally Stored Medications: LPA observed cabinet located in hallway to be locked and inaccessible to residents. LPA reviewed 2 out of 3 client medications and Medication Administration Record (MAR). Client #3 (C3) has no medications on file.

· Backyard: Clean and free from hazards. LPA observed plenty of seating and shade. No large bodies of water were observed.

LPA observed carbon monoxide in hallways. Smoke detector is hard wired and tested during visit. LPA observed multiple fully charged fire extinguishers throughout the facility. Administrator certificate was observed for Reuben Stewart with an expiration date of 07/20/24. Last fire drill was conducted on 06/05/23 at 10 am. First Aid kit was inspected. 3 out of 3 clients records were reviewed. Staff files were reviewed.

No deficiencies are being cited during visit. Exit interview was conducted with S2 and a copy of this report was provided via email due to printer problems.

SUPERVISORS NAME: Tony Vasallo
LICENSING EVALUATOR NAME: Kimberly Ramirez
LICENSING EVALUATOR SIGNATURE:

DATE: 06/17/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/17/2023
LIC809 (FAS) - (06/04)
Page: 2 of 2