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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198603557
Report Date: 09/03/2024
Date Signed: 09/03/2024 11:25:42 AM

Document Has Been Signed on 09/03/2024 11:25 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
GREATER LA AC/SC, 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:
09/03/2024
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:35 AM
MET WITH:Cynthia Garcia, StaffTIME VISIT/
INSPECTION COMPLETED:
11:30 AM
NARRATIVE
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Licensing Program Analyst (LPA) Cynthia Chan conducted a case management visit to issue deficiencies. LPA arrived unannounced and met with Lead Staff, Cynthia Garcia and David Baeza. The purpose of the visit was explained.

The case management visit is initiated due to information received regarding facility not meeting Title 22 regulations. On 8/27/24, the Department of Developmental Services and Regional Center personnel conducted a semiannual review at the facility. During their visit, it was noted that cleaning supplies were in unlocked cabinets in the kitchen and laundry room. In addition, the bathroom utilized by the client had excrement stains in the toilet, dust/hair build up around the toilet and base boards, and stains in the sink and counter.

Deficiencies are issued under the California Code of Regulations, Title 22. An exit interview was held. A copy of this report along with appeal rights was provided.

SUPERVISORS NAME: Tony Vasallo
LICENSING EVALUATOR NAME: Cynthia D Chan
LICENSING EVALUATOR SIGNATURE: DATE: 09/03/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/03/2024
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 09/03/2024 11:25 AM - It Cannot Be Edited


Created By: Cynthia D Chan On 09/03/2024 at 10:11 AM
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: 09/03/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
09/04/2024
Section Cited
CCR
80087(g)

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80087 Buildings and Grounds (g) Disinfectants, cleaning solutions, poisons, firearms and other items that could pose a danger if readily available to clients shall be stored where inaccessible to clients.
This requirement is not met as evidenced by:
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The administrator shall ensure all cleaning products are stored where they are inaccessible to clients.

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Based on observations, the licensee did not ensure cleaning supplies are locked and inaccessible to clients which poses a potential health and safety risk to clients in care.
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***During the visit today, LPA observed disinfectants and cleaning supplies locked in the cabinets. The deficiency has been cleared.
Type B
09/04/2024
Section Cited
CCR80087(a)

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80087 Buildings 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:
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The licensee shall ensure the facility is kept clean and sanitary at all times.
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Based on observations, the licensee did not the bathroom is kept clean and sanitary which poses a potential health and safety risk to clients in care.
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***During the visit today, LPA observed the bathrooms to be clean and sanitary.
The deficiency has been cleared.
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:Tony Vasallo
LICENSING EVALUATOR NAME:Cynthia D Chan
LICENSING EVALUATOR SIGNATURE:
DATE: 09/03/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/03/2024


LIC809 (FAS) - (06/04)
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