<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198603520
Report Date: 03/06/2023
Date Signed: 03/08/2023 01:46:10 PM

Document Has Been Signed on 03/08/2023 01:46 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:JOURNEY TOGETHER CARE HOMEFACILITY NUMBER:
198603520
ADMINISTRATOR:ARGUELLES, NELSONFACILITY TYPE:
735
ADDRESS:14627 LA PLUMA DRTELEPHONE:
(562) 217-7937
CITY:LA MIRADASTATE: CAZIP CODE:
90638
CAPACITY: 4CENSUS: 4DATE:
03/06/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
08:45 AM
MET WITH:Administrator Nelson Arguelles TIME COMPLETED:
01:40 PM
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) Jose Villalobos conducted an unannounced Annual Inspection visit. LPA met with Administrator Nelson Arguelles and the purpose of the visit was discussed.

LPA completed todays visit using the inspection tool and all its domains. The facility is approved to serve up to (4) clients of which all must be ambulatory. There are currently (4) clients in the facility and it is vendorized by Eastern Los Angeles Regional Center (ELARC).
The facility is a single-story home located in a residential neighborhood and consists of: Living room, dining area, kitchen, 3 bedrooms, 2 bathrooms, laundry area , front yard and backyard, attached garage for storage, and shaded areas for client use. LPA toured the physical plant and observed the following: Required postings were observed. Bedrooms contain the required furniture. The client’s bedrooms were inspected for safety, privacy, and comfort. The living areas are clean, bathrooms are clean and operational. First aid kit is fully stocked with manual, water temperature within title 22 regulation, adequate lighting, plenty of storage space was observed, working telephone, smoke and carbon monoxide detectors were in compliance, fire extinguishers are fully charged, medications were centrally stored and properly locked in the kitchen cabinet and records are current, ample supply of perishable and nonperishable food, adequate linen supply. No bodies of water present. Hazardous items are inaccessible to clients, yard free of debris and hazards. LPA reviewed (4) client files, (4) client medications, and (4) staff files during the visit.

LPA completed visit using the Inspection tools and no deficiencies are being cited. An exit interview was conducted and a copy of this report is being provided.
SUPERVISORS NAME: Fernando Fierros
LICENSING EVALUATOR NAME: Jose Villalobos
LICENSING EVALUATOR SIGNATURE: DATE: 03/06/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/06/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 1