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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198603462
Report Date: 07/07/2024
Date Signed: 07/07/2024 02:58:25 PM

Document Has Been Signed on 07/07/2024 02:58 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:CARING HEARTS HOMESFACILITY NUMBER:
198603462
ADMINISTRATOR/
DIRECTOR:		MANALD, RONALDFACILITY TYPE:
735
ADDRESS:18120 PUENTE ROADTELEPHONE:
(714) 398-4409
CITY:LA PUENTESTATE: CAZIP CODE:
91744
CAPACITY: 6CENSUS: 5DATE:
07/07/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:45 AM
MET WITH:Monaliza QuanTIME VISIT/
INSPECTION COMPLETED:
03:00 PM
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Licensing Program Analyst (LPA) Jose Villalobos conducted an unannounced Required- 1 year visit. LPA met with staff Monaliza Quan and explained the purpose of the visit. LPA utilized the Compliance and Regulatory Enforcement (CARE) tools for the visit. The following domains were completed:

Infection Control: Infection control practices and Personal Protective Equipment (PPEs) were observed. The facility has an Infection Control Plan in place. Staff are performing hand hygiene and adhering to infection control practices.

Operational Requirements: A current Plan of Operation was reviewed. Fire clearance was approved for six (6) ambulatory, of which two (2) may be non ambulatory. Fire and Disaster Drill was conducted 4/03/2024. Outdoor/backyard activity area provides a shaded area and furnished for outdoor use.

Physical Plant and Environmental: The facility is a single storey home located in a residential neighborhood, contains a total of four (4) client bedrooms, one (1) staff bedroom, one (1) office, two (2) full bathrooms, (1/2) bathroom, a living room, kitchen, dining area, backyard, and attached garage. Currently, there are five (5) clients living in the facility. The interior and exterior physical plant was inspected. Client bedrooms were toured. Each bedroom has a smoke detector, bed, linen, dresser, light, and sufficient closet space. Bathrooms have non-skid materials and contained hygiene supplies including liquid soap, paper towels, and toilet paper. Exit doors are free of any obstruction and there are no pools or large bodies of water. Laundry area is in the attached garage. Kitchen knives, sharps objects, cleaning supplies and toxic substances are locked and inaccessible to clients in care. One (1) fire extinguisher observed to be fully charged and serviced. Smoke alarms and carbon monoxide were tested and operable. There are no firearms or weapons stored at the facility. There are no cameras in the facility. Water temperature readings measured within Title 22 requirements.

Incidental Medical Services: There are no clients with restricted or prohibited health condition.
*****CONTINUED ON LIC809-C*****
SUPERVISORS NAME: Fernando Fierros
LICENSING EVALUATOR NAME: Jose Villalobos
LICENSING EVALUATOR SIGNATURE: DATE: 07/07/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/07/2024
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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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: 07/07/2024
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Staffing: Sufficient staffing observed during the visit. Sufficient staffing observed scheduled for the noc shift and able to provide care and supervision to clients.

Client Rights-Information: Client personal rights are posted. Facility provides internet services to all clients and have access to the facility phone. None of the clients have personal cell phones and computers/laptop.

Personnel Records/Staff Training: LPA reviewed four (4) Staff files. Staff employed are over the age of 18 and have criminal background clearance, fingerprint cleared, have training and associated to the facility. 1st Aid/CPR trainings are current. Administrator certificate is active. Administrator has a valid HIV/AIDS training proof at the time of visit. LPA conducted interviews for two (2) staff.

Client Records-Incident Reports: LPA reviewed five (5) Client files. Physician's Report (including TB and Ambulatory Status), Consent For Medical Treatment, Individual Program Plan (IPP), Behavioral Reports, Functional Assessment, Needs & Services Plan, Client Cash Resources, Special Incident Reports, Client Personal Property and Clients Personal Rights observed.

Food Service: There are sufficient food supplies of 7-day non-perishable items. The food is properly stored in the refrigerator (clean and well maintained). There are no clients with special diets residing at this facility. Pesticides and cleaning supplies are kept away from the food preparation areas and kept in locked cabinet in the garage. Plates, cups and utensils are kept cleaned and stored properly.

Health Related Services: The medications are centrally stored and in their original containers. (5) Client Medications were reviewed. Medications observed to be administered as prescribed by the Physician.

Disaster Preparedness: The facility has a complete Emergency Disaster and Mass Casualty Plan.

Emergency Intervention: Not-Applicable.

Pursuant to Title 22, no deficiencies are being cited on todays visit. An exit interview was conducted, and a copy of this report was provided.
SUPERVISORS NAME: Fernando Fierros
LICENSING EVALUATOR NAME: Jose Villalobos
LICENSING EVALUATOR SIGNATURE:

DATE: 07/07/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/07/2024
LIC809 (FAS) - (06/04)
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