198603485-8-5-2021-28-AS-AREA-C5LP78-20210805110331

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 198603485
Report Date: 08/05/2021
Date Signed: 08/05/2021 11:03:45 AM

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:	WHITTIER COTTAGE II		FACILITY NUMBER:	198603485
ADMINISTRATOR:	TRAZO-BOHANAN, VILMA		FACILITY TYPE:	740
ADDRESS:	16222 MARLINTON DR.		TELEPHONE:	(562) 315-9897
CITY:	WHITTIER	STATE: CA	ZIP CODE:	90604
CAPACITY:	6	CENSUS: 0	DATE:	08/05/2021
TYPE OF VISIT:	Prelicensing	ANNOUNCED	TIME BEGAN:	09:30 AM
MET WITH:	Vilma Trazo-Bohanan and James Trazo		TIME COMPLETED:	11:15 AM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	Licensing Program Analyst (LPA) Angelica Rea conducted an announced pre-licensing visit. LPA met with Administrators, Vilma Trazo-Bohanan and James Trazo. LPA Rea observed the following : This facility is located in a residential neighborhood, single story house, with (3) bedroom(s), (2) bathrooms, living room, dining area, laundry area, activity room, and kitchen. The fire alarms, smoke alarms and carbon monoxide detectors were tested and operate properly. The facility has central air and heating. All appliances in the kitchen were observed to be clean and operational. Sharp objects such as knives are stored in a locked kitchen drawer. There is (1) fire extinguisher located in the kitchen area. All cleaning solutions and chemicals are locked in a cabinet in the kitchen. The washer and dryer are located in the laundry area near the kitchen, and are operational. Medications will be stored in a locked cabinet in the hallway. First aid kit observed and inspected. Dining room has a table and sufficient seating for all residents. Resident room(s) were observed to have the required furniture such as bed frames, night stand, chairs and sufficient closet and drawer space. Bedrooms also have the required bedding. There are no staff bedrooms. The residents bathroom(s) have the required grab bars and non skid mats. There is sufficient lighting throughout the home. Window and window screens are in good repair. There are no security bars on the windows. There were no obstructions observed on the premises. The home has all the required posters posted. Resident and staff files were not reviewed since there are no residents living in the facility, but will be kept in a locked cabinet in the living room.

SUPERVISOR'S NAME: Lisa Hicks	TELEPHONE: (323) 981-3972
LICENSING EVALUATOR NAME: Angelica Rea	TELEPHONE: (323) 980-4929
LICENSING EVALUATOR SIGNATURE:	DATE: 08/05/2021

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/05/2021

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: WHITTIER COTTAGE II	FACILITY NUMBER: 198603485
	VISIT DATE: 08/05/2021

NARRATIVE

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The refrigerator was observed to be at 40 degrees Fahrenheit and the freezer at 0 degrees Fahrenheit.

The hot water temperature was measured in bathroom #1 and measured at 118.6 degrees F. The outdoor patio in the backyard was observed to have well shaded area and was furnished for outdoor use.

A sufficient supply of linens to permit weekly changing or more often to insure clean linens at all times for clients were observed to be kept in the hall linen closet. Personal hygiene supplies were observed readily available for client use. Activity supplies were observed and readily available for clients. Facility has working landline, and facility telephone was observed in the activity room.

No outstanding or pending items were observed by LPA requiring additional pre-licensing visits. LPA Rea will notify the assigned Centralized Applications Bureau (CAB) Analyst of the completed pre-licensing facility evaluation visit conducted, which included the Component III Orientation.

Exit interview conducted and a copy of this report was provided.

SUPERVISOR'S NAME: Lisa Hicks	TELEPHONE: (323) 981-3972
LICENSING EVALUATOR NAME: Angelica Rea	TELEPHONE: (323) 980-4929
LICENSING EVALUATOR SIGNATURE:	DATE: 08/05/2021

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/05/2021

LIC809 (FAS) - (06/04)

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