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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198603629
Report Date: 03/18/2024
Date Signed: 03/18/2024 03:13:37 PM

Document Has Been Signed on 03/18/2024 03:13 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:CITADEL HOMES 2 LLCFACILITY NUMBER:
198603629
ADMINISTRATOR:BUNDALIAN, CHRISTOPHERFACILITY TYPE:
735
ADDRESS:12231 183RD STTELEPHONE:
(562) 397-3192
CITY:ARTESIASTATE: CAZIP CODE:
90701
CAPACITY: 4CENSUS: 4DATE:
03/18/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:20 PM
MET WITH:Administrator Christopher Bunalian TIME COMPLETED:
03:28 PM
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On 3/18/24 at 12:20 p.m., Licensing Program Analyst (LPA) Jewel Baptiste conducted an unannounced Annual/Required inspection to Citadel Home #2. Upon arrival LPA was greeted by Direct Support Professional (DSP) Melanie Sorano who contacted the Administrator. The Administrator Christopher Bundalian arrived at 12:40 p.m., to assist with today's visit. The facility is license to serve age range 18 through 59. Approved for four (4) ambulatory, of which one (1) may be non-ambulatory and one (1) may be bedridden in room #1. Hospice approved for one (1) Dementia plan submitted. There were (4) clients in care during the time of this visit. The last emergency disaster/fire drill was conducted on 12/15/2023. The Administrator Certificate expires on 8/03/2024 #6053203735. During today's visit LPA inspected the physical plant inside and outside, reviewed the food supply, tested the smoke/carbon monoxide detectors, reviewed (3) staff files, (4) client files, medications, and medication administration records for (4) clients and P&I.

This home contains 4 resident bedrooms, 2 bathrooms, living room, kitchen, dining room, office space, storage room, and an attached garage. LPA toured the physical plant with the Administrator. and observed (3) resident bedrooms, contained required furniture, lamps, dresser, chair, and closet space. The remaining client was sleep and door is locked. The two bathrooms contain a working toilet, basin, and water faucet, walk in shower with grab bar, shower chair, and bathmat. The temperature measured at 115.8*F-117.5*F The smoke detectors were battery operated and tested and observed to be working properly. The carbon monoxide detector was located throughout the facility, tested, and functioning properly. There were (2) fire extinguishers located in kitchen and garage fully charged and up to date. The kitchen was toured and contained working appliances; refrigerator, stove, oven and contained dishware, cups, plates, utensils, pots, and pans with knives secured underneath kitchen sink. Cleaning agents and toxins were locked in the garage. The pantry was well stocked with canned goods, pasta, cereals, and the food supply contained a sufficient supply with a two-day supply of perishables and a seven-day supply of non-perishables that met title 22 guidelines. Walls and floors, cabinets and counters were clean and sanitary throughout the home.
(Report continued on LIC809C.)
SUPERVISORS NAME: Lisa Hicks
LICENSING EVALUATOR NAME: Jewel Baptiste
LICENSING EVALUATOR SIGNATURE: DATE: 03/18/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/18/2024
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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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: CITADEL HOMES 2 LLC
FACILITY NUMBER: 198603629
VISIT DATE: 03/18/2024
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The outdoor grounds were toured and inspected, and the patio was well maintained with a shaded seating area accessible for resident use. The garage contained a working washer and dryer, with cabinetry that contained emergency supply kits, bottled water, toiletries, personal care supplies, PPE supplies and toxins and cleaning agents.

The office space contained notifications and postings: California Labor Laws, Emergency Disaster Plan, personal rights, facility license, business license, medical emergency information, let-us-know licensing contact information, consumer grievance, support services, community resources and client hygiene schedule.

Exit interview conducted with Christopher Bundalian, Administrator, a copy of this report was provided.
SUPERVISORS NAME: Lisa Hicks
LICENSING EVALUATOR NAME: Jewel Baptiste
LICENSING EVALUATOR SIGNATURE:

DATE: 03/18/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/18/2024
LIC809 (FAS) - (06/04)
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