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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198603823
Report Date: 11/27/2024
Date Signed: 11/27/2024 10:01:29 AM

Document Has Been Signed on 11/27/2024 10:01 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
MONTEREY PARK ASC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754
FACILITY NAME:VISTA CARE RESIDENTIAL INC.FACILITY NUMBER:
198603823
ADMINISTRATOR/
DIRECTOR:		PASCASIO, GLORIEFACILITY TYPE:
735
ADDRESS:656 TONOPAH AVE.TELEPHONE:
(626) 241-4891
CITY:LA PUENTESTATE: CAZIP CODE:
91744
CAPACITY: 4CENSUS: 3DATE:
11/27/2024
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:23 AM
MET WITH:Administrator Glorie PascasioTIME VISIT/
INSPECTION COMPLETED:
10:00 AM
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Licensing Program Analysts (LPA's) Tyler Reyes conducted an announced Pre Licensing visit and met with Administrator Glorie Pascasio and Licensee Jessica Montesines. The purpose of the visit was to inspect the physical plant for licensing and to conduct the Component III orientation. The facility has a capacity of (4) four and will serve clients with an age 18- 59. Administrator Glorie's Adult Residential Facility (ARF) Certificate expires 01/04/2025.

The facility physical plant consists of a single story structure that consists of a living room, (4) client bedrooms, (1) staff office, (2) restrooms, kitchen, dining room, garage, front and backyard. Physical plant inside and outside is in good repair. Water temperature in restroom #1 measured at 105.8 degrees f. and restroom #2 water temperature measured at 108.8 degrees f. A first aid kit, along with current first-aid manual readily available was observed. LPA observed locked storage area for central storage of client’s medications. A designate locked area where cleaning supplies, poisons, and toxins will be kept separately from food supply storage. An outdoor activity space with shaded area and furnished for client outdoor was available.

LPA's and Administrator Glorie conducted a tour of facility and LPA's inspected the facility which consists of the following:

Passageway and doors are not blocked or obstructed.
Beds have the following required linen/supplies: pillowcase, fitted sheet, blanket and bedspreads.
Mattress and bedsprings are in good repair.
Clients furniture: one chair, night stand, adequate lighting for each client, and adequate closet and drawer space.
Refrigerator, stove, sinks, toilets and shower operate properly.

--Continued LIC 809-C---
SUPERVISORS NAME: Fernando Fierros
LICENSING EVALUATOR NAME: Tyler Reyes
LICENSING EVALUATOR SIGNATURE: DATE: 11/27/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/27/2024
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
MONTEREY PARK ASC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754
FACILITY NAME: VISTA CARE RESIDENTIAL INC.
FACILITY NUMBER: 198603823
VISIT DATE: 11/27/2024
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Cupboards, freezer, stove, microwave, refrigerator and counters are clean.
Freezer is 0 degrees Fahrenheit.
There was a 7 day supply of non-perishables available and a 2 day supply of perishables available.
Emergency disaster plan, and personal rights are posted
Smoke detectors and carbon monoxide detector operate properly and (2) fire extinguishers are properly charged.
There are no bodies of water located on the premises.
Adequate seating in common areas for licensed capacity.

Component III was also completed at the time of the visit and all required documents for Licensing were discussed.

Facility met the requirements as required per California Code of Regulations Title 22 Division 6.

Exit interview conducted and a copy of this report was provided to Administrator Glorie Pascasio
SUPERVISORS NAME: Fernando Fierros
LICENSING EVALUATOR NAME: Tyler Reyes
LICENSING EVALUATOR SIGNATURE:

DATE: 11/27/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/27/2024
LIC809 (FAS) - (06/04)
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