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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198603745
Report Date: 08/26/2024
Date Signed: 08/26/2024 10:50:18 AM

Document Has Been Signed on 08/26/2024 10:50 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:LEGACY CAREFACILITY NUMBER:
198603745
ADMINISTRATOR/
DIRECTOR:
PAREDES-ALEXANDER, YVONNEFACILITY TYPE:
735
ADDRESS:14368 RAMO DRIVETELEPHONE:
(213) 253-8551
CITY:LA MIRADASTATE: CAZIP CODE:
90638
CAPACITY: 4CENSUS: 0DATE:
08/26/2024
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:00 AM
MET WITH:Yvonne Paredes-Alexander - LicenseeTIME VISIT/
INSPECTION COMPLETED:
11:05 AM
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Licensing Program Analysts (LPA) Erik Zaragoza conducted an announced Pre-Licensing visit at the facility. LPA met with Yvonne Paredes-Alexander, Licensee for the facility, and explained the purpose of the visit. This Pre-Licensing inspection is being conducted as an initial application to be licensed.

The facility has an approved fire clearance to serve four (4) total ambulatory clients. The facility is a single-story home located in a residential neighborhood in the city of La Mirada. The facility consists of a living room, dining room, kitchen, laundry area, three (3) client bedrooms, and two (2) client bathrooms of which Restroom #1 had a hot water temperature reading of 109.7 degrees Fahrenheit, and Restroom #2 had a hot water temperature of 107.2 degrees Fahrenheit , as well as a back yard with shaded area and a detached garage.

The following was inspected during the evaluation with the Administrator and determined to be compliant with Title 22 Regulations. A locked storage area for central storage of medications was observed in the main closet of the facility. Cleaning supplies are kept separate from food supplies and are stored in the locked supply closet next to the laundry area of the facility. The walls, ceilings, floors, window screens and areas around the facility were clean and in good repair. Three (3) fire extinguishers were located throughout the facility. The carbon monoxide and smoke detector was observed to be operational. Doors, exits, hallways, and passageways were clear and free of obstruction. The front and back areas of the facility were observed to be clean and free of debris.

No pools or bodies of water were observed in or around the facility. An operating telephone was observed on the premises, which is easily accessible and available for resident use. The refrigerator was observed to be operable at 41 degrees and freezer below 0 degrees. The first-aid kit was reviewed and is kept locked in a main hallway of the facility. Activities were observed to be available for the clients as well.

The COMP III was waived by the licensee who currently operates two (2) other community care licensing facilities, facility has passed the inspection. Exit interview held and a copy of the report was provided.

SUPERVISORS NAME: David Sicairos
LICENSING EVALUATOR NAME: Erik Zaragoza
LICENSING EVALUATOR SIGNATURE: DATE: 08/26/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/26/2024
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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