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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198603557
Report Date: 03/14/2025
Date Signed: 03/14/2025 01:16:13 PM

Document Has Been Signed on 03/14/2025 01:16 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:PEOPLE'S CARE NOGALFACILITY NUMBER:
198603557
ADMINISTRATOR/
DIRECTOR:		JASMIN SMITHFACILITY TYPE:
737
ADDRESS:8716 NOGAL AVENUETELEPHONE:
(909) 287-3557
CITY:WHITTIERSTATE: CAZIP CODE:
90606
CAPACITY: 4CENSUS: 3DATE:
03/14/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:30 AM
MET WITH:Jasmin SmithTIME VISIT/
INSPECTION COMPLETED:
01:20 PM
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Licensing Program Analyst (LPA) Galarza conducted an unannounced Required- 1 year visit. The purpose of the visit was explained to Administrator Jasmin Smith. The facility is as an Enhanced Behavioral Support Home (EBSH) for developmentally disabled adults ages 18-59 years old vendored by Eastern Los Angeles Regional Center.

The following were observed/inspected:



Infection Control: The Infection Control Plan was reviewed. The facility has sufficient supply of Personal Protective Equipment (PPEs).

Physical Plant/Environment Safety: The EBSH home is a single-story home consisting of three (3) bedrooms, two (2) full bathrooms, one (1) 1/2 bathroom, kitchen, dining room, living room, laundry room, office, a detached activity room. There is an assembly/recreation area with a basketball court located in the rear of the property. The backyard has a covered patio area with patio furniture. Water temperature readings measured within the required 105 - 120 degrees Fahrenheit. The facility has a 1st Aid Kit and Manual. Cleaning supplies, knives, and toxic substances were locked and inaccessible to residents.

The facility has an approved fire clearance for secured perimeter with delayed egress that is operational. The home is equipped with automatic sprinkler system and fire door. Exit doors are free of any obstruction and there are no pools or large bodies of water. Smoke and carbon monoxide detectors were tested and are operational. There is a fire extinguishers in the facility. *Fire Door does not close properly. A citation was issued.

Operational Requirements: Fire clearance is approved for four (4) non-ambulatory residents. The last fire inspection was conducted on 7/15/24 by Hue & Cry Inc. Special equipment and supplies is used by a resident. The Surety Bond is current. Care and supervision to meet the clients needs was observed. Two residents require 2 to 1 staff ratio and one resident requires 1 to 1 staff in the home and community.

SUPERVISORS NAME: Lisa Hicks
LICENSING EVALUATOR NAME: Noemi Galarza
LICENSING EVALUATOR SIGNATURE: DATE: 03/14/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/14/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.

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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: PEOPLE'S CARE NOGAL
FACILITY NUMBER: 198603557
VISIT DATE: 03/14/2025
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Staffing: A total of 25 staff members provide care and supervision to the clients. 11 out of 25 staff are Registered Behavior Technicians (RBT's).

Personnel Records/Staff Training: Administrator certificate expires 12/9/2026. Staff have criminal background clearance and training. Six (6) staff files were reviewed. Proof of staff training, health and TB clearance, RBT and/or DSP, 1st Aid/CPR training are on file. Consultant logs, RBT Log, and CEUs & Certifications were reviewed.

Client Rights/Information: Physician orders, and personal rights were reviewed in client files.

Client Records/Incident Reports: Three (3) resident files were reviewed. Admission agreements, Physician's Report, medical/functional assessments, Needs and Services Plans, TB clearance, IPP reports, personal rights, medical consent, dietician report, consultant logs, Personal & Incidental (P & I) monies/records, and Medication Administration Records were reviewed. HCBS Tenant/Landlord Agreements are in files. P & I money records were reviewed.

Food Service: The kitchen was inspected and has sufficient supply of 2 day perishable & 7 day non-perishable food. Kitchen, food preparation area, and storage areas were observed to be clean and sanitary. No residents have a modified diet.

Health Related Services: Residents are assisted with self administration of prescription and non-prescription medications. Centrally stored resident medication records were reviewed and are given according to Physician directions. 30-Day supply of medications were reviewed.

Incident Medical and Dental: All residents have updated consultant assessments, Physician Reports, and COVID-19 vaccination cards on file.

Disaster Preparedness, and Emergency Intervention: Emergency Disaster Plan was reviewed. The plan shall be reviewed annually, updated as necessary, and maintained on file at the facility. First Aid Kit and Manual were observed. The last emergency drill was conducted on 2/5/2025.

Emergency Intervention: Manual restraints are implemented by staff if needed via CPI techniques.

Per Title 22, California Code of Regulations, a deficiency was cited.



Exit interview conducted with Administrator Jasmin Smith. A copy of the report and appeal rights were issued.
SUPERVISORS NAME: Lisa Hicks
LICENSING EVALUATOR NAME: Noemi Galarza
LICENSING EVALUATOR SIGNATURE:

DATE: 03/14/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/14/2025
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Document Has Been Signed on 03/14/2025 01:16 PM - It Cannot Be Edited


Created By: Noemi Galarza On 03/14/2025 at 01:04 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: 03/14/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
80087(a)
Building and Grounds
(a) The facility shall be clean, safe, sanitary and in good repair at all times for the safety and well-being of clients, employees and visitors.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, the licensee did not comply with the section cited above in that the fire door in the hallway did not close properly when the smoke detectors were tested, which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 04/11/2025
Plan of Correction
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Administrator agrees to submit picture/video proof of correction along with proof of invoice. If an extension is needed an extension request must be submit 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:Noemi Galarza
LICENSING EVALUATOR SIGNATURE:
DATE: 03/14/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/14/2025


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