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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198603662
Report Date: 06/27/2023
Date Signed: 06/27/2023 01:52:13 PM


Document Has Been Signed on 06/27/2023 01:52 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:GLENDORA CARE HOMESFACILITY NUMBER:
198603662
ADMINISTRATOR:SANTOS, LUIS GABRIELFACILITY TYPE:
740
ADDRESS:339 W. CITRUS EDGE STREETTELEPHONE:
(909) 592-6497
CITY:GLENDORASTATE: CAZIP CODE:
91740
CAPACITY:6CENSUS: DATE:
06/27/2023
TYPE OF VISIT:Case Management - OtherANNOUNCEDTIME BEGAN:
01:13 PM
MET WITH:Rowena and Luis Gabriel Santos. Administrator TIME COMPLETED:
02:03 PM
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Licensing Program Analyst (LPA) Alberto Lopez generated a subsequent pre-licensing report as a follow up to the initial pre-licensing visit conducted on 05/25/2023. During the initial pre-licensing visit applicant had a few corrections needed prior to obtaining a license.

LPA Lopez and Administrator toured the physical plant and observed the following items were corrected:

1. Two perimeter doors on the two sides of home were repaired or replaced to allow residents, staff and visitors to exit.
2. Licensee obtained Ombudsman poster and post it in facility
3. Proof of required liability insurance.
4. Solid wastes containers were purchased and have tight-fitting covers on the containers
5. Storage and preservation of medications, including the storage of medications that require refrigeration was addressed
6. Water temperature was adjusted to between 105 – 120 degrees F.

Accordingly, LPA will submit a copy of this Facility Evaluation Report to the Central Applications Bureau (CAB) for review. If Licensee Applicant Representative has questions regarding the status of the application, they have been instructed to communicate with their CAB Analyst assigned to process their application.

LPA observation of the physical plant at the time of this report did not require other corrections.


The physical plant is cleared as of today, 6/27/2023. Exit interview conducted with Administrator Rowena and Luis A Santos.

SUPERVISOR'S NAME: Lisa HicksTELEPHONE: (323) 981-3972
LICENSING EVALUATOR NAME: Alberto LopezTELEPHONE: 323-980-4926
LICENSING EVALUATOR SIGNATURE:
DATE: 06/27/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/27/2023
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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