198603654-7-6-2023-28-AS-CWOG-CTGUPE-20230706154524

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 198603654
Report Date: 07/06/2023
Date Signed: 07/06/2023 06:22:19 PM

Document Has Been Signed on 07/06/2023 06:22 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:	PARKER CARE HOMES		FACILITY NUMBER:	198603654
ADMINISTRATOR:	BEEK, KEVIN VAN		FACILITY TYPE:	735
ADDRESS:	18414 DRAGONERA DR.		TELEPHONE:	(714) 393-6361
CITY:	ROWLAND HEIGHTS	STATE: CA	ZIP CODE:	91748
CAPACITY: 6		CENSUS: 6	DATE:	07/06/2023
TYPE OF VISIT:	Prelicensing	UNANNOUNCED	TIME BEGAN:	01:35 PM
MET WITH:	Kevin Van Beek		TIME COMPLETED:	04:20 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	Licensing Program Analyst (LPA), Christine Wong, conducted an announced visit to the facility for purpose of a prelicensing evaluation and LPA met with Administrator Kevin Van Beek and assisted with the visit. An application was submitted to CCLD on 01/18/2023, for Change of Ownership for a Adult Residential Facility] to serve Developmentally Disabled Adults for age range 18 through 59. The requested capacity is for six (6) where three (3) can be non-ambulatory in Room#3 and #4. During today's visit, LPA Wong utilized the Compliance and Regulatory Enforcement (CARE) tools for the pre-licensing visit today : 1. Physical Plant and Environmental Safety: The facility is a single story house and its located in a residential neighborhood area. The facility includes: living room, dining area, kitchen, four (4) clients bedrooms and three(3) bathrooms, staff office and attached garage. The client bedrooms are spacious and will easily accommodate the client's furnishings. The passageway, walkways, driveways and patio are free from obstructions. There shall be no more than two clients per bedroom. Bedroom#1 and #4 has two beds, two chairs, two night stands, drawers, required beddings and sufficient lighting and closet space. Bedroom#2 and #3 has one bed, one chair, one night stand, drawer and required bedding and sufficient lighting and closet space. All three (3) clients bathrooms are clean and sanitary and has a working toilet and bath-tub/shower. There is one bathroom (Bathroom#3) that will accommodate non-ambulatory clients in a wheel chair. Each client's bed have the required linen/supplies which include, pillowcase, mattress pads, fitted sheet, blanket and bedspreads. Adequate supply of linen stored in hallway cabinet and garage. The facility also has a ample supply of personal hygiene products and stored in the cabinet in the garage. The smoke detectors and carbon monoxide detectors are located in each client's bedroom and common area and they are all working probably. The stove burners, oven, microwave, washer and dryer are working probably. All the cleaning supplies are stored and locked under the sink and in the garage and inaccessible to clients.

SUPERVISORS NAME: David Sicairos
LICENSING EVALUATOR NAME: Christine Wong
LICENSING EVALUATOR SIGNATURE:	DATE: 07/06/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/06/2023

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
GREATER LA AC/SC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754

FACILITY NAME: PARKER CARE HOMES	FACILITY NUMBER: 198603654
	VISIT DATE: 07/06/2023

NARRATIVE

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The hot water temperature in all three bathrooms were tested between 113 and 114 degrees F. The facility has a telephone land-line system and the facility phone # is 626-723-4858. All the facility Posted & readily available for review on the wall near bedroom#1. The facility would turn on the hallway light at night. The facility also has flash night for emergency use.

2. Operational Requirement: The facility fire clearance were approved on 02/24/23 with three (3) ambulatory and three (3) non-ambulatory clients. The weekly menu is posed on the refrigerator in the kitchen. The facility has board games, books, and other recreational materials for the client's use and placed around the dining area, commensurate with the plan of operation. The backyard has a shaded area with tables and chairs for client to utilize. Applicant will be handling cash resources of clients and has a surety bond for $5000, cash resources will be locked and stored with P & I Ledger, accessible to designated staff.

3. Personnel Record-Training: All staff files are maintained and stored in the facility and located in the file cabinet in the staff office. When the administrator is absent and it will be a designated staff to cover administrator responsibility. The LIC308 was also completed.

4.Client Records-Incident Reports: All clients staff are maintained and stored in the facility and located in the file cabinet in the living room. The client register is posted on the wall near the bedroom#1

5.Client's Right-Information: The facility will ensure each client has their personal right to be accorded safe, healthful and comfortable accommodations.

6.Food Service: The facility refrigerator has a measured temperature of at least 45 degrees Fahrenheit for appropriate food storage. Freezer is at (0) zero degrees Fahrenheit. Dishes, cups and flat ware are stored in the kitchen cabinet inspected and in good repair. Knives, cutlery and other sharp kitchen utensils are stored and locked in the kitchen cabinet. Food supply adequate stored in the refrigerator and pantry and consists of the following: 2 days perishable and 7 days non-perishable.

7. Health Related Services: The medication will be centrally stored and locked in the facility file cabinet near the dining area, The first aid kit has been inspected which has at least the following: thermometer, tweezers, scissors, antiseptic, bandages, gauze and current first aid manual, which are stored in the medication cabinet near the dining area and available for staff use but inaccessible to clients.

SUPERVISORS NAME: David Sicairos
LICENSING EVALUATOR NAME: Christine Wong
LICENSING EVALUATOR SIGNATURE:	DATE: 07/06/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/06/2023

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
GREATER LA AC/SC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754

FACILITY NAME: PARKER CARE HOMES	FACILITY NUMBER: 198603654
	VISIT DATE: 07/06/2023

NARRATIVE

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8. Disaster Preparedness: The facility has an updated emergency disaster plan dated on 6/8/23 posted on the wall next to the bedroom#1 and has at least two alternative temporary shelter location.

Component III:
Conducted at the Pre-Licensing visit, information provided about how to operate the facility within substantial compliance.

An exit interview was conducted and a copy of this report has been furnished to the applicant. Accordingly, LPA will submit a copy of this facility evaluation report to the Centralized Applications Bureau (CAB) for review. If the applicant has questions regarding the status of the application, they have been instructed to communicate with the CAB Analyst assigned to their application.

SUPERVISORS NAME: David Sicairos
LICENSING EVALUATOR NAME: Christine Wong
LICENSING EVALUATOR SIGNATURE:	DATE: 07/06/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/06/2023

LIC809 (FAS) - (06/04)

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