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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198603610
Report Date: 01/28/2025
Date Signed: 01/28/2025 10:23:30 AM

Document Has Been Signed on 01/28/2025 10:23 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:RISING HILL DEVELOPMENTAL HOME IIIFACILITY NUMBER:
198603610
ADMINISTRATOR/
DIRECTOR:
OGLESBY, JENNIFER L.FACILITY TYPE:
735
ADDRESS:21303 E CLOVERTON STTELEPHONE:
(562) 508-2007
CITY:COVINASTATE: CAZIP CODE:
91724
CAPACITY: 4CENSUS: 4DATE:
01/28/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:30 AM
MET WITH:Jennifer Oglesby, Licensee and
Eric Howard, adminsitrator
TIME VISIT/
INSPECTION COMPLETED:
10:30 AM
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Licensing Program Analysts (LPAs) Tao and DeLeon conducted an unannounced annual inspection. The facility is licensed to serve four (4) ambulatory, age 18-59 clients. San Gabriel Pomona Regional Center provides case management service to clients. Facility annual fees are current.

LPAs met Licensee, Jennifer Oglesby and discussed the purpose of today's visit. The inspection consisted of applying CARE tool, conducting physical plant, reviewing staff/clients records /food supply/medications and interviewed staff. All clients were out in the community.

The facility was a single-family house. There were four (4) client bedrooms, two (2) bathrooms, kitchen, dining area near the kitchen, living room with a TV, family room, laundry area in the garage and backyard with a patio. The kitchen was clean and has maintained the required two (2) days perishable and seven (7) days nonperishable. Clients’ bedrooms had the required furnishing and in compliance. Bathrooms were clean and operational. Common areas including the kitchen, living room, and dining room were inspected. Smoke and carbon monoxide detectors were operable and in compliance. The last Fire/ Emergency Drill was conducted on 01/26/25. Hot water temperature was measured at 109.5 degrees F. Hazardous items were inaccessible to clients. Medications were centrally stored and locked in a cabinet. Medications records were properly logged. Hazardous items were inaccessible to clients. Fire extinguishers were fully charged and last services on 11/17/24.

No deficiencies were cited per California Code of Regulations, Title 22, Division 6. An exit interview was conducted. LIC 809 was provided to Jennifer Oglesby, Licensee.
SUPERVISORS NAME: Fernando Fierros
LICENSING EVALUATOR NAME: Bonnie Tao
LICENSING EVALUATOR SIGNATURE: DATE: 01/28/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/28/2025
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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