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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198603759
Report Date: 02/18/2025
Date Signed: 02/18/2025 12:01:07 PM

Document Has Been Signed on 02/18/2025 12:01 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
CCLD Regional Office, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754
FACILITY NAME:FT. KNOXFACILITY NUMBER:
198603759
ADMINISTRATOR/
DIRECTOR:
HARDEN, LANIKAFACILITY TYPE:
735
ADDRESS:16332 E. EDNA PLACETELEPHONE:
(626) 394-1461
CITY:COVINASTATE: CAZIP CODE:
91722
CAPACITY: 4CENSUS: 3DATE:
02/18/2025
TYPE OF VISIT:Case Management - Health ChecksUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:58 AM
MET WITH:Latonda Knox, Assistant AdministratorTIME VISIT/
INSPECTION COMPLETED:
12:05 PM
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Licensing Program Analyst (LPA) Noemi Galarza made unannounced case management visit regarding the relocation of 3 residents from Ft. Knox Supportive Housing Inc. 288 W. Terrace St, Altadena, CA 91001 to Ft. Knox due to mandatory evacuation orders from Fire Advisory as a result of the Eaton Fire. LPA met with Assistant Administrator Latonda Knox and explained the purpose of the visit. A physical plant tour of the facility was conducted to check the health and safety of the 3 evacuee residents.

The following observations were made:
  • All 3 relocated residents have designated rooms with beds, bedding/linen, and hygiene supplies. Two (2) residents use medical equipment and are non-ambulatory. One (1) resident is ambulatory.
  • Medication Administration Records (MARs), medications, and resident file documents were reviewed.
  • A total of 6 staff are employed at the facility.
  • Residents were transferred with medical insurance information and file documents. San Gabriel/Pomona Regional Center was notified and have conducted 3 site visits.
  • Review of staff rosters indicate there is sufficient staffing available to provide care for residents.
  • The facility has sufficient 2-day perishable and 7-day non perishable food supplies.
  • The fire inspection was conducted on 11/13/2024.
  • Residents were evacuated to this facility on 1/8/2025.
  • Administrator notified all residents responsible parties of relocation.

*NOTE: Due to the relocation of non-ambulatory evacuees a change of occupancy is pending. Licensee was instructed to submit required documents to CCL once the Fire Department change of occupancy is approved.

Exit interview was conducted with Assistant Administrator Latonda Knox. A copy of the report was issued.

SUPERVISORS NAME: Lisa Hicks
LICENSING EVALUATOR NAME: Noemi Galarza
LICENSING EVALUATOR SIGNATURE: DATE: 02/18/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/18/2025
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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