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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198603557
Report Date: 02/23/2024
Date Signed: 02/27/2024 07:55:05 AM

Document Has Been Signed on 02/27/2024 07:55 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:PEOPLE'S CARE NOGALFACILITY NUMBER:
198603557
ADMINISTRATOR:JASMIN SMITHFACILITY TYPE:
737
ADDRESS:8716 NOGAL AVENUETELEPHONE:
(909) 287-3557
CITY:WHITTIERSTATE: CAZIP CODE:
90606
CAPACITY: 4CENSUS: 2DATE:
02/23/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:00 PM
MET WITH:Cynthia Garcia - House Lead TIME COMPLETED:
02:30 PM
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Licensing Program Analyst (LPA) Angelica Rea conducted an annual/required visit. LPA met with House Lead, Cynthia Garcia and explained the reason for the visit. Ms. Garcia assisted with today's visit. Administrator, Jasmin Smith arrived at the facility a short time later.

LPA Rea and Ms. Garcia toured the facility inside and out, reviewed food supply, reviewed resident medications, and reviewed client and staff files. Passageways are clear and free of obstructions. The front and backyard are well maintained. The backyard has patio furniture and a shaded area. There are no pools or large bodies of water. Cleaning supplies, toxins, and sharp objects are inaccessible to clients. Facility maintains a comfortable temperature. There is sufficient lighting throughout the facility including bedrooms and common areas. The client bedrooms have the required furniture such as bed frames, dresser drawers, lamps and lift systems. There is sufficient closet space for each client. The client bathroom was observed to be clean during the visit and had the required equipment to meet the clients needs. The hot water temperature was tested in 3 bathrooms, and the kitchen, and measured 113.2, 113.6, 119.6 and 116.1, respectively, which is within the required range of 105-120 degrees. The smoke detectors/carbon monoxide detectors were tested during the visit and were operating properly. The last disaster drill was conducted on 01/12/2024. Copy of surety bond was observed.

Per California Code of Regulations, Title 22, and California Health and Safety Code, there were deficiencies observed during the visit.

Exit interview conducted, appeal rights and a copy of report was provided.
SUPERVISORS NAME: Lisa Hicks
LICENSING EVALUATOR NAME: Angelica Rea
LICENSING EVALUATOR SIGNATURE: DATE: 02/23/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/23/2024
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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Document Has Been Signed on 02/27/2024 07:55 AM - It Cannot Be Edited


Created By: Angelica Rea On 02/23/2024 at 02:03 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754

FACILITY NAME: PEOPLE'S CARE NOGAL
FACILITY NUMBER: 198603557

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/23/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
80069(b)(1)


This requirement is not met as evidenced by: Resident #1 did not have a medical assessment in her file.
Deficient Practice Statement
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Based on record review, the licensee did not comply with the section cited above in 1 out of 2 resident files reviewed, which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 03/15/2024
Plan of Correction
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Administrator will ensure that Title 22 regulations are being adhered to, as required. Administrator will ensure that resident #1 has a completed medical assessment by POC due date.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Lisa Hicks
LICENSING EVALUATOR NAME:Angelica Rea
LICENSING EVALUATOR SIGNATURE:
DATE: 02/23/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/23/2024


LIC809 (FAS) - (06/04)
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