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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198603759
Report Date: 01/10/2025
Date Signed: 01/10/2025 11:40:31 AM

Document Has Been Signed on 01/10/2025 11:40 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:FT. KNOXFACILITY NUMBER:
198603759
ADMINISTRATOR/
DIRECTOR:		KNOX, LATONDAFACILITY TYPE:
735
ADDRESS:16332 E. EDNA PLACETELEPHONE:
(626) 394-1461
CITY:COVINASTATE: CAZIP CODE:
91722
CAPACITY: 4CENSUS: 3DATE:
01/10/2025
TYPE OF VISIT:PrelicensingANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:00 AM
MET WITH:Latonda Knox, applicantTIME VISIT/
INSPECTION COMPLETED:
11:45 AM
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Licensing Program Analyst (LPA) Tao conducted an announced pre-licensing inspection. LPA met with Latonda Knox, applicant/ administrator.

Applicant is applying for Adult Residential Facility to serve clients for age range from 18 years old through 59 years old. This is an initial application. The requested capacity is four (4), ambulatory only. Currently, there are three (3) clients residing at the facility due to the emergency evacuation of Eaton fire. Facility receives case management services provided by San Gabriel / Pomona Regional Center.

Fire clearance:
Fire clearance is granted for four (4) ambulatory clients on 10/18/24.

Structure:
The property is a single-family residence located in a residential neighborhood and consist of four (4) client bedrooms, two (2) client bathrooms, living room, kitchen, dining room, laundry room, office area, and detached garage. Passageways, walkways and patios are free from obstructions. The entrance and side areas are free of hazards and debris. Garage is not accessible to clients. Facility had no pool or bodily of water.

(- continued on LIC 809 C -)
SUPERVISORS NAME: Fernando Fierros
LICENSING EVALUATOR NAME: Bonnie Tao
LICENSING EVALUATOR SIGNATURE: DATE: 01/10/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/10/2025
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 3
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: FT. KNOX
FACILITY NUMBER: 198603759
VISIT DATE: 01/10/2025
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Bedrooms and Bathrooms for Clients:
Bedrooms are spacious, accommodated for clients and in compliance with regulation. Bathrooms have grab bars maintained for each toilet, bathtub and shower.

Linens & Hygiene Supplies:
Sufficient linen/supplies which include pillowcases, mattress pads, blanket and bedspreads are available. Adequate supply of linen, wash clothes and towels are observed.

Food Service:
Facility had the required food wares stored in the kitchen cupboards and kitchen appliances in place which were inspected and in good repair. Food supply consist of two days of perishable and two weeks of non-perishable was observed.

Smoke Detectors:
Smoke /carbon monoxide detectors are tested and operable which are located in hallways and each bedroom.

Toxins:
Poisons, toxins, and cleaning supplies are locked and inaccessible to clients. They are stored separately from food source.

Emergency Phone Numbers, Exit Plan, Signages and posters:
Emergency Disaster Plan and Labor law poster are posted. Exit Plan are available for review. (-continued on LIC 809 C-)
SUPERVISORS NAME: Fernando Fierros
LICENSING EVALUATOR NAME: Bonnie Tao
LICENSING EVALUATOR SIGNATURE:

DATE: 01/10/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/10/2025
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
CCLD Regional Office, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754
FACILITY NAME: FT. KNOX
FACILITY NUMBER: 198603759
VISIT DATE: 01/10/2025
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Outdoor activity area in backyard:
Outdoor activity area is furnished with chairs and table and in compliance. Shaded area in the backyard at the outdoor activity area is provided.

Clients & Staff Files:
Locked cabinets for records of staff and clients are installed and available. Clients’ files are observed. Applicant will handle cash resources for clients.

Water Temperature/ Fire extinguishers:
Water was measured at 116.6 degrees Fahrenheit which was in compliance with Reg Title 22. Fire extinguisher was fully charged which was mounted on the kitchen wall. The last service was on 10/18/24.

Menu and phone:
Menus are available for review. Free landline telephone is available for clients’ use and operable.

Findings/ Exit:
No issue was observed during today’s visit. Exit conference was conducted. LPA conducted Component III orientation to applicant during the pre-licensing visit.

A copy of this report was provided to applicant. 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, s/he has been instructed to communicate with the CAB Analyst who assigned to his/her application.
SUPERVISORS NAME: Fernando Fierros
LICENSING EVALUATOR NAME: Bonnie Tao
LICENSING EVALUATOR SIGNATURE:

DATE: 01/10/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/10/2025
LIC809 (FAS) - (06/04)
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