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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306002525
Report Date: 08/19/2022
Date Signed: 08/19/2022 12:06:41 PM


Document Has Been Signed on 08/19/2022 12:06 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, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868



FACILITY NAME:NEW ERA GUEST HOME IIFACILITY NUMBER:
306002525
ADMINISTRATOR:JOSEFINA GUTIERREZFACILITY TYPE:
740
ADDRESS:9831 ROYAL PALM BLVD.TELEPHONE:
(714) 583-8643
CITY:GARDEN GROVESTATE: CAZIP CODE:
92841
CAPACITY:6CENSUS: 5DATE:
08/19/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
08:58 AM
MET WITH:Josefina GutierrezTIME COMPLETED:
11:25 PM
NARRATIVE
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Licensing Program Analyst (LPA) Joseph Alejandre made an unannounced visit to conduct the required annual inspection (mitigation). LPA was greeted and granted entry by staff. LPA met with Administrator Josefina Gutierrez. LPA explained the reason for the visit Josefina Gutierrez has an Administrator's Certificate that expires on 11/17/2022. LPA and Administrator toured the facility. Facility has 7 bedrooms and 4 bathrooms. The master bedroom is for live in staff and has a private bathroom. The master bedroom is kept locked and inaccessible to residents in care. All residents have private bedrooms. All resident bedrooms had the required furnishings and were clean and organized. All 4 bathrooms were clean and operational. LPA measured the hot water in the 3 resident bathrooms. Hot water measured 123.0 degrees Fahrenheit to 128.0 degrees Fahrenheit. At the time of the visit there were 2 staff present, 5 residents and an adult (A1) living at the facility who is not a staff member or a resident in care. A review of Guardian showed A1 was not associated to the facility and did not have a background clearance. LPA instructed the Administrator to have A1 leave the facility and informed her that they must be background cleared and associated to the facility before they return. Administrator stated she understood. LPA observed A1 leaving the facility. LPA inspected the kitchen. The kitchen was clean and organized. LPA observed 2 day perishable and 7 day non-perishable food on hand. Smoke detectors/carbon monoxide detectors tested operational. LPA and Administrator toured the garage. The garage is kept locked and used for storage. LPA and Administrator toured the backyard. LPA observed a shed in the backyard. The shed is kept secured and used for storage. No bodies of water observed. Both exit pathways leading to the front of the house are free from obstacles and hazards. Both exit gates are operational. LPA did not observe any obstacles or hazards inside or outside of the facility.

Deficiencies, citations and civil penalty and appeal rights were issued per Title 22 Division 6 of the California Code of Regulations (CCR). See LIC809-D, dated 8/19/22 and LIC421BG dated 8/19/22. An exit interview was conducted and a copy of the report provided.
SUPERVISOR'S NAME: Luz AdamsTELEPHONE: (714) 703-2855
LICENSING EVALUATOR NAME: Joseph AlejandreTELEPHONE: (951) 473-7041
LICENSING EVALUATOR SIGNATURE:
DATE: 08/19/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/19/2022
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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Document Has Been Signed on 08/19/2022 12:06 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868


FACILITY NAME: NEW ERA GUEST HOME II
FACILITY NUMBER: 306002525

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/19/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
87355(b)
Prior to the Department issueing a license, the applicant, Administrator, and any adults other than a client, residing in the facility shall have criminal record clearance or exemption

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, interview with the Administrator and record review the licensee did not comply with the section cited above in 1 out of 2 adults residing at the facility who are not clients which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 08/20/2022
Plan of Correction
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Licensee will ensure that all staff and adults residing at the facility who are not clients will receive clearance prior to being present at the facility. Licensee sent the adult in question to be fingerprinted/cleared during the visit and agreed not have them return until they are cleared and associated to the facility. Licensee to send proof of background clearance to LPA by 8/22/2022.
Type A
Section Cited
CCR
87303(e)(2)
Faucets used by residents for personal care such as shaving and grooming shall deliver hot water. Hot water temperature controls shall be maintained to automatically regulate the temperature of hot water used by residents to attain a temperature not less than 105 degrees F (41 degrees C) and not more than 120 degrees F (49 degrees C).

This requirement is not met as evidenced by:
Deficient Practice Statement
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LPA measured the hot water temperature in 3 out of 4 bathrooms and the temperature measured 123.0 degrees Fahrenheit to 128.0 degrees Fahrenheit. This poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 08/20/2022
Plan of Correction
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Licensee will adjust the water temperature to be within regulation requirements and check the water temperature weekly to ensure it is maintained at the proper temperature.

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Luz AdamsTELEPHONE: (714) 703-2855
LICENSING EVALUATOR NAME: Joseph AlejandreTELEPHONE: (951) 473-7041
LICENSING EVALUATOR SIGNATURE:
DATE: 08/19/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/19/2022
LIC809 (FAS) - (06/04)
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