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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198603508
Report Date: 03/18/2022
Date Signed: 03/18/2022 10:09:13 AM

Document Has Been Signed on 03/18/2022 10:09 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:REM CALIFORNIA, LLC - BELLFLOWERFACILITY NUMBER:
198603508
ADMINISTRATOR:MANALASTAS, ALBERTOFACILITY TYPE:
735
ADDRESS:6129 BELLFLOWER BLVDTELEPHONE:
(568) 925-0141
CITY:LAKEWOODSTATE: CAZIP CODE:
90713
CAPACITY: 4CENSUS: 4DATE:
03/18/2022
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Alberto Manalastas - AdministratorTIME COMPLETED:
10:25 AM
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Licensing Program Analyst (LPA) Mora conducted an announced Pre-Licensing visit. LPA met with Administrator Alberto Manalastas and explained the reason for the visit. An application was submitted to Community Care Licensing Department (CCLD) for a change in ownership of an Adult Residential Facility to serve 3 ambulatory and 1 non-ambulatory clients in the age range of 18 through 59.

A tour of the single-story facility included: living room, kitchen, 4 client bedrooms, 2 bathrooms, laundry area, staff office, detached garage, front yard, and backyard.

LPA Mora conducted the tour with Alberto Manalastas and observed the following: sufficient food supplies for at least 2 days of perishables and 7 days of non-perishables were observed in the kitchen and in the refrigerators located in the garage. Sharps and First Aid kit are kept locked in a kitchen cabinet. Chemical solutions are kept locked under the kitchen's sink. The First Aid kit was fully stocked with all required items including a current manual. There is a closet in the hallway with clean towels and extra linen. Dining and living room have sufficient lighting and sitting area. Medications are centrally stored in a locked kitchen cabinet. All bedrooms have all required furniture, lighting, and bedding. Both bathrooms were observed with shower mats. Water temperature was tested at 113.7 degrees F, which is within the required 105-120 degrees F. Fire extinguishers were observed in the laundry area and kitchen, and fully charged. Smoke detectors were observed throughout the facility and in each room and were operable during the visit. Carbon monoxides were observed in the kitchen, hallway and laundry area, and were operable during the visit. The front yard and backyard are clean, and there is a shaded sitting area in the backyard. No bodies of water were observed at the facility. Passageways and exits are free of obstruction. LPA reviewed all 4 of the clients’ medications and files. Medications are documented properly and given as prescribed. Client files are complete and updated. LPA reviewed 3 staff files. Staff files are complete and updated. LPA observed administrator certificate for Alberto Manalastas #6050299735 with an expiration date of 05/20/2022.
(CONTINUED TO LIC 809C)
SUPERVISORS NAME: Stefanie Coronel
LICENSING EVALUATOR NAME: Luis Mora
LICENSING EVALUATOR SIGNATURE: DATE: 03/18/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/18/2022
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: REM CALIFORNIA, LLC - BELLFLOWER
FACILITY NUMBER: 198603508
VISIT DATE: 03/18/2022
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No outstanding or pending items were observed by LPA requiring additional pre-licensing visits. LPA 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 to the Administrator.
SUPERVISORS NAME: Stefanie Coronel
LICENSING EVALUATOR NAME: Luis Mora
LICENSING EVALUATOR SIGNATURE:

DATE: 03/18/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/18/2022
LIC809 (FAS) - (06/04)
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