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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198603484
Report Date: 08/03/2022
Date Signed: 08/04/2022 08:18:50 AM

Document Has Been Signed on 08/04/2022 08:18 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:CANYON RIMFACILITY NUMBER:
198603484
ADMINISTRATOR:EVE, AUCIONE COELHOFACILITY TYPE:
735
ADDRESS:6512 BEQUETTE AVETELEPHONE:
(562) 395-8118
CITY:PICO RIVERASTATE: CAZIP CODE:
90660
CAPACITY: 4CENSUS: 3DATE:
08/03/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:30 AM
MET WITH:Les Eve TIME COMPLETED:
12:45 PM
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Licensing Program Analyst (LPA) Christine Wong conducted an unannounced annual required visit. LPA met with Administrator Les Eve and explained the reason for the visit. Shortly after, the licensee Aucione Eve arrived. 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: living room, dining area, kitchen, two clients bedrooms, two bathrooms, one isolation/covid-19 room, staff office and a detached garage. Each clients bedrooms has two bed, two night stand, two drawers, required bed linen and furniture and sufficient lighting and closet space. The two bathrooms also toured and they are clean, sanitary and in a good working condition. The hot water temperature in two bathrooms were tested between 108.3 and 110 degrees F which is within Title 22 regulation. The refrigerator in the kitchen, kitchen cabient and the garage have sufficient for two days perishable and seven days non perishable food supply. All the appliances in the kitchen are clean are working properly. The sharp knives and utensils are locked in the cabinet under the fish tank. All the cleaning supplies are locked under the sink which is inaccessible to clients. The common areas such as living room and dining area are clean and have the required furniture. The front and back yard are maintained well and the back yard has a shaded area and sitting area. LPA also inspected the smoke detectors and carbon monoxide detectors and they are all interconnected and working well.

LPA reviewed 3 clients' files to confirm emergency contact is updated. LPA also reviewed two staff files to confirm health screenings and fingerprint clearances. All two staff are fingerprint cleared and they all have updated health screening in the personnel file. All clients medication are centrally stored and locked in the kitchen cabinet and LPA reviewed all two clients medication and they are updated and accurate.
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: CANYON RIM
FACILITY NUMBER: 198603484
VISIT DATE: 08/03/2022
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Facility is currently following COVID 19 recommendations regarding COVID 19 signs throughout the facility, The disinfecting products are available in each bathroom and common area and the facility is disinfected every shift and the bathrooms have sufficient soap, paper towels, and signs. PPE supplies are also sufficient for more than 30 days.

No deficiencies were observed during today's visit.

An exit interview was conducted and a copy of this report was provided to Administrator Les Eve.
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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