198603528-2-23-2023-28-AS-KRAZ-CPBW4Z-20230223155823

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 198603528
Report Date: 02/23/2023
Date Signed: 02/23/2023 03:58:30 PM

Document Has Been Signed on 02/23/2023 03:58 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
GREATER LA AC/SC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754

FACILITY NAME:	WARVALE FACILITY		FACILITY NUMBER:	198603528
ADMINISTRATOR:	HERNANDEZ, YESSICA		FACILITY TYPE:	735
ADDRESS:	8740 WARVALE ST.		TELEPHONE:	(323) 346-3450
CITY:	PICO RIVERA	STATE: CA	ZIP CODE:	90660
CAPACITY: 4		CENSUS: 2	DATE:	02/23/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	02:00 PM
MET WITH:	Administrator Edgar Hernandez		TIME COMPLETED:	04:15 PM

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Licensing Program Analyst (LPA) Kimberly Ramirez conducted an unannounced Annual Required Visit on 02/23/2023 at 1:45 pm. LPA was met by Administrator Edgar Hernandez and explained the purpose of the visit. Facility is licensed to serve clients 18 to 59 years old. The facility has a fire clearance approved for four (4) ambulatory. There are two (2) level 4I developmentally disabled clients residing at this facility. Clients at this facility are receiving services from ELARC Regional Center. LPA requested and obtained a copy of Personnel Report (LIC 500), and Resident Roster (LIC 9020).

LPA OBSERVATIONS: Tour began at 2:10 pm and was led Administrator Hernandez. The Facility is a single-story building located in a residential area with two (2) client shared bedrooms, one (1) client shared bathroom, one (1) staff bedroom, one (1) staff bathroom, kitchen, dining room, front yard, backyard and attached car garage.

· Front Yard: Was clean and well maintained. No hazards were observed.

· Kitchen: LPA observed kitchen to be clean and appliances appeared to be in working order. LPA observed sufficient 2 days of perishables and 7-day supply on non-perishables. Kitchen sink water temperature was measured at 119.3 degrees F. At 2:17 pm, LPA observed knives and sharps located under kitchen cabinet to the left of stove, to be inaccessible to 2 out of 2 clients in care. At 2:19 pm, LPA observed several bottles of cleaning solution and disinfectants, to be inaccessible to 2 out of 2 clients in care. LPA observed staff preparing lunch for clients during tour. Signs promoting hand washing were observed in this area.

· Dining Room/Living room: Dining room was observed to be clean and contained one table and 5 chairs. Living room was observed to contain 1 love seat and 1 couch. Thermostat located near living room was observed at 68 degrees F. Signs promoting cough/sneeze etiquette were observed throughout this area.

· Linen Closet: Contained plenty linens, towels, and hygiene products.

SUPERVISORS NAME: Tony Vasallo
LICENSING EVALUATOR NAME: Kimberly Ramirez
LICENSING EVALUATOR SIGNATURE:	DATE: 02/17/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/17/2023

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
GREATER LA AC/SC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754

FACILITY NAME: WARVALE FACILITY	FACILITY NUMBER: 198603528
	VISIT DATE: 02/23/2023

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·Client Rooms 1 - 2: All contained the required furnishings, linens and were observed to be clean. Client bedroom #1 is a shared bedroom. Client bedroom #2 is currently unoccupied.

· Bathrooms: Shared client bathroom# 1 was observed to be clean and contained soap and paper towels. Signs promoting hand washing were observed. Grab bars were observed near toilet and shower. Water temperature in this bathroom was measured at 119.4 degrees F which is in the required 105 – 120 degrees F.

· Centrally Stored Medications: LPA’s observed cabinet located near kitchen to be locked and inaccessible to residents. Medications were reviewed.

· Attached Garage: LPA observed extra bedding supplies, cleaning products and hygiene products. Garage was locked and inaccessible to residents.

· Backyard: Clean and free from hazards. LPA observed plenty of seating and shade.

LPA observed carbon monoxide in hallways. Smoke detector is hard wired and tested during visit. Administrator certificate was observed for Edgar Hernandez with an expiration date of 01/17/24. Last fire drill was conducted on 02/8/23.

No deficiencies are being cited during visit. Exit interview was conducted with Administrator Hernandez and a copy of this report was provided.

SUPERVISORS NAME: Tony Vasallo
LICENSING EVALUATOR NAME: Kimberly Ramirez
LICENSING EVALUATOR SIGNATURE:	DATE: 02/23/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/23/2023

LIC809 (FAS) - (06/04)

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