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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198603462
Report Date: 08/03/2022
Date Signed: 08/04/2022 08:12:48 AM

Document Has Been Signed on 08/04/2022 08:12 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:CARING HEARTS HOMESFACILITY NUMBER:
198603462
ADMINISTRATOR:MANALD, RONALDFACILITY TYPE:
735
ADDRESS:18120 PUENTE ROADTELEPHONE:
(714) 398-4409
CITY:LA PUENTESTATE: CAZIP CODE:
91744
CAPACITY: 6CENSUS: 6DATE:
08/03/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:20 PM
MET WITH:Ronald Manalad TIME COMPLETED:
02:50 PM
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Licensing Program Analyst (LPA) Christine Wong conducted an unannounced annual required visit. LPA met with administrator Ronald Manalad and explained the reason for the visit. LPA used the infection control tool to evaluate the facility. LPA observed the facility plant, COVID-19 procedures, reviewed clients' medications, observed food supply, and reviewed clients' and staff files.

The facility is a single story house and located in a residential neighborhood area. The facility includes: dining area, kitchen, living room, four clients bedrooms, two bathrooms, staff office, staff break room and attached garage. All four clients bedrooms were toured. Bedroom#1 and #3 has one bed, one chair, one drawer, required bed linen and furniture and sufficient lighting and closet space. Bedroom#2 and #4 has two beds, two chairs, two drawers, required bed linen and furniture and sufficient lighting and closet space. The two bathrooms were toured and they are clean, sanitary and in a good working condition. The hot water temperature in two bathrooms and kitchen were tested between 105.9 and 114 degrees F which is within Title 22 regulation. The refrigerator in the kitchen and garage and the storage room has sufficient food supply for two days perishable and seven days non-perishable. All the appliance in the kitchen are clean and working properly. The sharp knives and utensils are stored under the sink and inaccessible for the clients. The common area such as living room and dining area are clean and have the required furniture. The front and back yard are maintained well and back yard has a shaded area and sitting area for clients to utilize. The cleaning supplies are located in the locked cabinet in the garage which is inaccessible for clients. LPA inspected the smoke detectors and carbon monoxide detectors and they are all interconnected and working well.

LPA reviewed 6 clients' files to confirm emergency contact is updated. LPA also reviewed two staff files to confirm health screenings and fingerprint clearances. The two staff are fingerprint cleared and also have updated health screening in their personnel file. LPA also inspected all 6 clients medication and all medication are centrally stored in the locked cabinet near the living room and they are all accurate and updated.
SUPERVISORS NAME: Christine Yee
LICENSING EVALUATOR NAME: Christine Wong
LICENSING EVALUATOR SIGNATURE: DATE: 08/03/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/03/2022
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754
FACILITY NAME: CARING HEARTS HOMES
FACILITY NUMBER: 198603462
VISIT DATE: 08/03/2022
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Facility is currently following COVID 19 recommendations regarding COVID 19 signs throughout the facility, facility is disinfected the facility twice a day, clients bathrooms have sufficient soap, paper towels, and signs, PPE supplies are sufficient for more than 30 days.

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 the administrator.

SUPERVISORS NAME: Christine Yee
LICENSING EVALUATOR NAME: Christine Wong
LICENSING EVALUATOR SIGNATURE:

DATE: 08/03/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/03/2022
LIC809 (FAS) - (06/04)
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