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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198603724
Report Date: 07/09/2024
Date Signed: 07/09/2024 10:35:05 AM

Document Has Been Signed on 07/09/2024 10:35 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
GREATER LA AC/SC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754
FACILITY NAME:PHILADELPHIAN HOME IIFACILITY NUMBER:
198603724
ADMINISTRATOR/
DIRECTOR:		RESURRECCION, LEANDROFACILITY TYPE:
735
ADDRESS:10136 WASHINGTON STTELEPHONE:
(562) 732-7514
CITY:BELLFLOWERSTATE: CAZIP CODE:
90706
CAPACITY: 4CENSUS: 0DATE:
07/09/2024
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:35 AM
MET WITH:LEANDRO RESURRECCION - LICENSEETIME VISIT/
INSPECTION COMPLETED:
11:50 AM
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Licensing Program Analyst (LPA) Tena Herrera conducted an announced pre-licensed visit and met with Licensee Leandro Resurreccion and Administrator Marie Resurreccion for the purpose of conducting a Pre-Licensing Inspection / Component III visit.

The facility has an approved fire clearance to be licensed to serve a capacity of four (4), (2) non-ambulatory in rooms 1&2 and (2) ambulatory in rooms 3&4. This is a single-story home located in a residential area in Bellflower, Ca. A tour of the facility includes: living room, dining room, activity area, kitchen, 4 bedrooms, 2 bathrooms, detached garage with laundry area, front yard and back yard.

The physical plant was toured inside and out alongside Leandro and Marie Resurreccion.


The following was observed/inspected:

· There is a locked storage area that is centrally located for medication located in the dining area.

· Cleaning supplies are kept separate from food and located in a locked cabinet under kitchen sink (surplus is locked in detached garage storage closet).

· Facility walls, ceilings, floors, window screens and areas around the facility are clean and in good repair.

· Fire extinguisher and smoke detectors operate properly.

· Doors and passageways are free of obstruction.

· There are no pools/bodies of water at the facility.

· Facility does not have firearms on premises.

(Continued on 809-C)

SUPERVISORS NAME: David Sicairos
LICENSING EVALUATOR NAME: Tena Herrera
LICENSING EVALUATOR SIGNATURE: DATE: 07/09/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/09/2024
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: PHILADELPHIAN HOME II
FACILITY NUMBER: 198603724
VISIT DATE: 07/09/2024
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· There is an emergency exiting plan with emergency phone numbers posted.

· Facility has a current disaster and mass casualty plan maintained at the facility.

· There is a plan for employee accommodations and staffing arrangements.

· Operating telephone and desktop computer on the premises and will be available to clients.

· Client Records have a designated area within a locked closet for safe keeping.

· There is a linen closet with extra linens and towels.

· Facility has a laundry area within the detached garage.

· First-aid supplies are maintained and readily available.

· Refrigerator and freezer were observed and are maintained at the correct temperatures.

· Food storage and preparation are clean and appropriate for food preparation.

· Sufficient amount of food is readily available to meet the needs of the clients.

· Hot water temperature was tested and is within the required range of 105-120 degrees F.

· Facility access van has valid insurance and registration.

Component III was completed during todays visit and reviewed by Leandro and Marie Resurreccion.

An exit interview was conducted, and a copy of this report has been furnished to Licensee Leandro Resurreccion. Accordingly, LPA will submit a copy of this facility evaluation report to the Central 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: Tena Herrera
LICENSING EVALUATOR SIGNATURE:

DATE: 07/09/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/09/2024
LIC809 (FAS) - (06/04)
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