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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198603467
Report Date: 04/12/2024
Date Signed: 04/12/2024 11:58:11 AM

Document Has Been Signed on 04/12/2024 11:58 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
MONTEREY PARK ASC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754
FACILITY NAME:PEOPLE'S CARE LOMITASFACILITY NUMBER:
198603467
ADMINISTRATOR/
DIRECTOR:		JILLIAN FLORESFACILITY TYPE:
738
ADDRESS:14055 LOMITAS AVENUETELEPHONE:
(626) 474-2500
CITY:LA PUENTESTATE: CAZIP CODE:
91746
CAPACITY: 4CENSUS: 3DATE:
04/12/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:49 AM
MET WITH:Jillian Flores- AdministratorTIME VISIT/
INSPECTION COMPLETED:
12:15 PM
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Licensing Program Analyst (LPA) Sanjay Vaid conducted an unannounced Required- 1 year visit using the full Care Compliance and Regulatory Enforcement (CARE) Tools. Upon arriving at the facility, LPA met with Staff – Ziggy Tua and was later joined by the Administrator- Jillian Flores who assisted with the visit. LPA explained the purpose of this visit. There are three (3) ambulatory developmentally disabled clients residing at the facility. The facility is licensed as an Adult Residential Facility (ARF) for clients who are between the ages of 18 through 59, vendor is San Gabriel/Pomona Regional Center (SGPRC).

The facility is located in a residential neighborhood and is a one story building which consists of four (4) client bedrooms, two (2) bathrooms, living room, activity room, dining room, kitchen, office, laundry room, and detached garage. The facility has a fire clearance from the local Fire Department for a capacity of four (4) non-ambulatory clients ages 18 - 59, approved for delayed egress on perimeter exterior. The interior and exterior physical plant was inspected. Exit doors are free of any obstruction and there are no pools or large bodies of water. Smoke and carbon monoxide detectors are operational. The facility has three (3) fully charged fire extinguishers. Cleaning supplies and toxic substances are inaccessible to clients. Water temperature readings were measured between the required 105 - 120 degrees Fahrenheit.
Care and supervision to meet the clients needs was observed. No special equipment and supplies are used by clients. Current Surety bond was reviewed and is current.
A random selection of staff files were reviewed for criminal background clearance and training. Personnel records have health/TB screenings, CPI training, certifications, and 1st Aid/CPR training. Physician orders, and personal rights were reviewed in client files. Monthly emergency drills are conducted.

No deficiencies were observed during this visit. An exit interview was conducted and a copy of this report was provided to the Administrator Jillian Flores
SUPERVISORS NAME: Fernando Fierros
LICENSING EVALUATOR NAME: Sanjay Vaid
LICENSING EVALUATOR SIGNATURE: DATE: 04/12/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/12/2024
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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