<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198603731
Report Date: 06/20/2024
Date Signed: 06/20/2024 10:55:02 AM

Document Has Been Signed on 06/20/2024 10:55 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
CCLD Regional Office, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754
FACILITY NAME:TEMMERA RESIDENCEFACILITY NUMBER:
198603731
ADMINISTRATOR/
DIRECTOR:		LOPEZ, LORRAINE FRANCESFACILITY TYPE:
740
ADDRESS:368 TEMMERA LANETELEPHONE:
(626) 890-7634
CITY:GLENDORASTATE: CAZIP CODE:
91740
CAPACITY: 6CENSUS: 0DATE:
06/20/2024
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:00 AM
MET WITH:Lorraine Lopez- ApplicantTIME VISIT/
INSPECTION COMPLETED:
11:00 AM
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) V. Maldonado made an announced visit to the facility for the purpose of conducting the Pre-Licensing visit using the Compliance and Regulatory Enforcement (CARE) Tool, to evaluate the facility. LPA Maldonado met with Applicants Lorraine Lopez, Megan Hill, and Andres Castellanos.

This is a new facility. Applicant has requested to operate as a Residential Care Facility for the Elderly (RCFE). Fire clearance has been approved to serve (6) older adults, ages 60 and over, of which (5) will be non-ambulatory, and (1) will be bedridden. Bedridden resident approved in room#2 only. Applicant has also requested to care for residents with dementia, and has a pending Dementia Care Plan. An Infection Control plan has been submitted and approved by the department. The facility has an active and current liability insurance policy on file.

The facility is a single-story home located in a residential area. It consists of (4) resident bedrooms, (2) full bathrooms, a kitchen, dining room, living room, attached garage, and shaded patio area with sufficient seating for residents. There is sufficient indoor and outdoor activity space for residents.. Resident bedrooms were observed to have the required furniture, sufficient lighting, and closet/storage space. Resident bathrooms are equipped with required grab bars and non-skid mats. The showers accommodate non-ambulatory residents. The hot water was tested and measured between 111*F-114*F, which is in compliance. Food supplies was observed and was sufficient as required. Fire extinguishers were observed throughout, with current inspections and were fully charged. All sharps and cleaning supplies/toxins were observed to be locked and inaccessible to residents in care. Auditory devices were observed at all entrances/exits of facility and were operational. There were no bodies of water observed on the premises. All required postings were observed throughout the facility. Sufficient additional linens/towels were observed. The washer and dryer, PPE, hygiene supplies, and cleaning supplies are located in the garage. They are kept locked and inaccessible to residents at all times.
(Report continued on LIC809-C...)
SUPERVISORS NAME: Fernando Fierros
LICENSING EVALUATOR NAME: Valeria Maldonado
LICENSING EVALUATOR SIGNATURE: DATE: 06/20/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/20/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 2
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: TEMMERA RESIDENCE
FACILITY NUMBER: 198603731
VISIT DATE: 06/20/2024
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
26
27
28
29
30
31
32
Sharps/knives are locked in a lockbox in the kitchen and inaccessible to residents. Sufficient additional linens were observed, available for residents and in good repair. There is a central storage area for files and medication equipped with locks. First aid kits were inspected and observed to have the required supplies and first aid manual to meet Title 22 Regulations. Smoke/Carbon monoxide detectors are interconnected. They were tested during the visit and and operational.

LPA Maldonado has cleared the physical plant. The applicants have waived Component III Orientation as it was recently completed for another facility they have licensed.

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 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: Fernando Fierros
LICENSING EVALUATOR NAME: Valeria Maldonado
LICENSING EVALUATOR SIGNATURE:

DATE: 06/20/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/20/2024
LIC809 (FAS) - (06/04)
Page: 2 of 2