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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198603598
Report Date: 12/19/2024
Date Signed: 12/19/2024 05:46:33 PM

Document Has Been Signed on 12/19/2024 05:46 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
GREATER LA AC/SC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754
FACILITY NAME:ROWLAND HEIGHTS RESIDENTIAL CAREFACILITY NUMBER:
198603598
ADMINISTRATOR/
DIRECTOR:
SINGH, EILEENFACILITY TYPE:
735
ADDRESS:1404 KINGSMILL AVETELEPHONE:
(951) 440-3292
CITY:ROWLAND HEIGHTSSTATE: CAZIP CODE:
91748
CAPACITY: 4CENSUS: 0DATE:
12/19/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
02:00 PM
MET WITH:Eileen Singh, AdministratorTIME VISIT/
INSPECTION COMPLETED:
04:00 PM
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Licensing Program Analyst (LPA) Cynthia Chan conducted the annual inspection on 12/19/24. LPA arrived unannounced and met with Administrator, Eileen Singh. The purpose for the visit was explained. The facility is licensed for 4 ambulatory clients only. There are currently no clients residing at the home.

The single story facility consists of 4 client bedrooms, 2 bathrooms (1 of which is located in bedroom #3), living room, dining area, kitchen, and attached garage. The backyard has a swimming pool that is drained and covered and has a 5 feet fence on the perimeter. Each client bedroom has the required furniture such as a bed, a night stand, chair, and closet space. There are hallway lights. There are smoke and carbon monoxide combo detectors located in each bedroom and hallways. The hot water temperature was measured at 115.3 degrees F. Appliances are working properly. Knives and sharps will be locked in a safe. Cleaning supplies and detergents are locked in the garage cabinet. Extra linens and hygiene supplies are available.
Food supplies for non-perishable are observed. However, per administrator, perishable items will be purchased once a client is admitted.
The administrator's certificate expires on 4/9/26 and the TB & HIV training certificate was issued on 3/16/24. There were no other staff and client files to review.
No medications were reviewed.
Emergency Disaster Plan and Infection Control Plan have been updated and reviewed annually.

No deficiencies were issued. A copy of this report was given to the administrator.
SUPERVISORS NAME: Tony Vasallo
LICENSING EVALUATOR NAME: Cynthia D Chan
LICENSING EVALUATOR SIGNATURE: DATE: 12/19/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/19/2024
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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