198603654-7-11-2024-28-AS-CWOG-D73SRK-20240711140627

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 198603654
Report Date: 07/11/2024
Date Signed: 07/11/2024 02:08:32 PM

Document Has Been Signed on 07/11/2024 02:08 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:	07/11/2024
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	11:45 AM
MET WITH:	Kevin Van Beek-Administrator		TIME COMPLETED:	02:20 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) Wong conducted an unannounced Required- 1 year visit using the full Care Compliance and Regulatory Enforcement (CARE) Tools. LPA met with DSP Monica Gallargo and explained the reason of the visit and allowed the entry of the facility. Shortly after, the administrator Kevin Van Beek arrived and assisted with the visit. The facility is approved for serve Developmentally Disabled Adults 18-59 years old and fire clearance approved for six (6) where three (3) can be non-ambulatory. The facility is licensed as a level 4G vendored by San Gabriel Pomona Regional Center. The following twelve (12) tool domains were observed and reviewed: Infection Control, Physical Plant/Environmental Safety, Operational Requirements, Staffing, Personal Records-Training, Client Rights/Information, Client Records/Incident Reports, Food Service, Health Related Services, Incidental Medical Services, Disaster Preparedness and Emergency Intervention. 1. Infection Control: Infection control practices and Personal Protective Equipment (PPEs) were observed. The facility still encourages hand washing. The facility has updated infection control plan in place. 2. Physical Plant and Environmental Safety: The facility is a single story house and located in a residential neighborhood area. The facility includes living room, kitchen, dining area, four clients bedrooms, three clients' bathrooms and attached garage. Clients bedroom#1 and #4 have two beds, two night stands, two chairs, two drawers, required furniture and beddings and sufficient lighting and closet space. Client bedroom#2 and #3 has one bed, one chair, one drawer required furniture and beddings and sufficient lighting and closet space. The three client's bathrooms are sanitary, clean and in a good working condition. The hot water temperature in three clients bathrooms were tested between 106.8 and 107.4 degrees F which is within Tile 22 regulation. LPA inspected the carbon monoxide detectors and it's working well. LPA observed the sharp knives were locked in the kitchen cabinet. All the chemicals and cleaning supplies were locked under the sink and inaccessible to clients. The extra personal hygiene products were stored in the file cabinet in the garage. (See LIC809C for continuation)

SUPERVISOR'S NAME: David Sicairos	TELEPHONE: (323)980-4934
LICENSING EVALUATOR NAME: Christine Wong	TELEPHONE: (323) 981-3963
LICENSING EVALUATOR SIGNATURE:	DATE: 07/11/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/11/2024

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

FACILITY NAME: PARKER CARE HOMES	FACILITY NUMBER: 198603654
	VISIT DATE: 07/11/2024

NARRATIVE

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The hallway night is always on during night time so client can have access to the non-private bathrooms. The facility has a telephone service in the premises.

3. Operational Requirement: The facility is approved for six (6) where three (3) can be non-ambulatory. Currently the facility has two client are non-ambulatory. The last fire drill was conducted on 06/03/24. The clients can attend the community events if there's any opportunity or chance. The backyard has a shaded area with table and chairs for client to utilize the outdoor activity.

4. Staffing: The facility has sufficient staffing in the facility to provide care and supervision to clients. The NOC shift staff has the required training for facility planned emergency procedure training.

5. Personnel Record: All the staff files are computerized and administrator has the access to the staff files. All the staff in the facility are over 18 years old, fingerprint cleared and associated with the facility. LPA reviewed two staff files and the administrator files and they all have the required documents in their personnel files which include: employment application, Health screening, TB test result, updated first aid certificate and required training hours. The facility administrator is Kevin Van Beek and his administrator certificate is effective through 9/18/2024 and the administrator has the required training hours for HIV and TB.

6. Client's Right Information: Currently the facility has no client required any postural support.

7. Food Service: The facility provide three meals and snacks to client per day. The facility has sufficient two days perishable and seven days non perishable food supply in the facility. There's no client in the facility is required any modified diet that's prescribed by the doctor but the facility would chop up the food for clients. All the food in the facility are stored properly.

8. Client-Record/Incident Reports: All the clients files are stored in the file cabinet near the living room. All client files have the required documents included: face sheet, updated physician and dental report, TB test result, functional capacity assessment, admission agreement and updated Individual Program Plan. LPA also inspected client's P&I monies and and it's updated and accurate.

SUPERVISOR'S NAME: David Sicairos	TELEPHONE: (323)980-4934
LICENSING EVALUATOR NAME: Christine Wong	TELEPHONE: (323) 981-3963
LICENSING EVALUATOR SIGNATURE:	DATE: 07/11/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/11/2024

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: 07/11/2024

NARRATIVE

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9. Health Related Services: The facility would assist client to arrange all the medical and dental appointments and provide transportation too. All the medication in the facility are centrally stored and locked in the file cabinet near the dining area. LPA inspected all six (6) clients medication and all the medication are seemed to be accurate and updated. LPA also inspected the first aid kit and it's locked in the cabinet near the kitchen and they have all the required supplies in the kit.

10. Incidental Medical Services: There's no client in the facility with any restricted health condition or prohibited health condition.

11. Disaster Preparedness: The facility has an updated Emergency Disaster Plan (LIC610D) in place. The last disaster drill was conducted on 5/10/24 and the facility has two alternative shelter location.

12. Emergency Intervention: It's not applicable for the facility as they do not do restraint on clients.

NO deficiencies were observed during the visit.

Exit Interview conducted and a copy of the report was provided to the administrator Kevin Van Beek.

SUPERVISOR'S NAME: David Sicairos	TELEPHONE: (323)980-4934
LICENSING EVALUATOR NAME: Christine Wong	TELEPHONE: (323) 981-3963
LICENSING EVALUATOR SIGNATURE:	DATE: 07/11/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/11/2024

LIC809 (FAS) - (06/04)

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