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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198603450
Report Date: 07/21/2023
Date Signed: 07/25/2023 08:15:33 AM

Document Has Been Signed on 07/25/2023 08:15 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:CL HOMES RESIDENTIAL CARE, LLC - CL HOME 3FACILITY NUMBER:
198603450
ADMINISTRATOR:LOPEZ, MELISSA M.FACILITY TYPE:
735
ADDRESS:9922 COLIMA ROADTELEPHONE:
(562) 889-8327
CITY:WHITTIERSTATE: CAZIP CODE:
90603
CAPACITY: 4CENSUS: 4DATE:
07/21/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Emiliano Chavez, and Norma GarciaTIME COMPLETED:
12:30 PM
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 LPA Angelica Rea made an unannounced visit to CL Homes Residential Care, LLC - CL Home 3.
The purpose of today’s visit was to conduct the Required Inspection. On today’s visit LPA met with Administrator, Emiliano Chavez.

LPA Rea checked Resident & Staff files, medications, staff fingerprint clearances, staff 1st aid certificates, consumer IPPs and inspected the home for hazards. During this visit, LPA inspected resident bedrooms, two bathrooms, living room, dining room and kitchen, and laundry area. The resident bedrooms were inspected for linens and personal accommodations for safety, privacy, and comfort. Bedrooms had plenty of dresser and closet space observed. Walls and floors were in good condition. Hallways were clean, clear, and free of debris. Toilets and water facets worked properly. Water temperature measured between 105 degrees F and 120 degrees F in kitchen and bathroom sinks. The fire extinguisher is fully charged and meets regulations. The facility conducted a fire drill on 6/20/23.

Perishable and Non-perishable food supply was checked and adequately stocked at time of visit. Smoke detectors/Carbon monoxide detectors were tested and working properly, chemical compounds and knives were locked and inaccessible to clients. Medications were centrally stored and properly locked, first aid kit was checked and in order. Outside grounds were toured and no bodies of water were observed.

No deficiencies cited. Exit Interview, and copy of report, provided to Ms. Garcia.
SUPERVISORS NAME: Lisa Hicks
LICENSING EVALUATOR NAME: Angelica Rea
LICENSING EVALUATOR SIGNATURE: DATE: 07/21/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/21/2023
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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