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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306003743
Report Date: 10/09/2023
Date Signed: 10/09/2023 03:02:13 PM

Document Has Been Signed on 10/09/2023 03:02 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:DEL SOL HOME (ARTESIA)FACILITY NUMBER:
306003743
ADMINISTRATOR:MERCI CANIA GONZALESFACILITY TYPE:
735
ADDRESS:12060 ARTESIA BLVD., EASTTELEPHONE:
(562) 860-1538
CITY:ARTESIASTATE: CAZIP CODE:
90701
CAPACITY: 4CENSUS: 4DATE:
10/09/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:24 PM
MET WITH:Administrator Mark De OcampoTIME COMPLETED:
03:16 PM
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On 10/09/23 at 12:24 p.m., Licensing Program Analyst (LPA) Jewel Baptiste conducted an unannounced Annual/Required inspection to Del Sol Home (Artesia). Upon arrival LPA was greeted by Direct Support Professional (DSP) Maribel Sebastian who contacted the Administrator. The Administrator Mark De Ocampo arrived at 1:30 and LPA explained the reason for the visit. This home is licensed to serve (4) Developmentally Disabled Adults, (3) non-Ambulatory and (1) Ambulatory Adults ages 18 through 59 with restricted health conditions. The home is vendorized by Harbor Regional Center. There were (4) clients in care during the time of this visit. The last emergency disaster/fire drill was conducted on 10/02/23. The Administrator Certificate expires on 06/06/2024 #6048592735. During today's visit LPA inspected the physical plant inside and outside, reviewed the food supply, tested the smoke/carbon monoxide detectors, reviewed (4) staff files, (4) client files, medications, and medication administration records for (4) clients and P&I.

This home contains 4 bedrooms, 1 staff bathroom, 1 client bathroom, living room, office space, kitchen, dining room and an attached garage. LPA toured the physical plant with the DSP Maribel Sebastin and Co-Administrator Ann Tomilloso. LPA observed all (4) client bedrooms, contained required furniture, lamps, dresser, chair, and closet space. The two bathrooms contain a working toilet, basin, and water faucet, walk in shower with grab bar, and shower chair. The temperature measured at 108.6 degrees*F. The smoke detectors were battery operated tested and observed to be working properly. The carbon monoxide detector was located throughout the facility, tested, and functioning properly. There were (1) fire extinguishers located in kitchen fully charged and up to date. The kitchen was toured and contained working appliances; refrigerator, stove, oven and contained dishware, cups, plates, utensils, pots, and pans. The knives are secured and locked in a kitchen draw. The cleaning agents and toxins were locked underneath kitchen sink. The pantry was well stocked with canned goods, pasta, cereals, and the food supply contained a sufficient supply with a two-day supply of perishables and a seven-day supply of non-perishables that met title 22 guidelines. Walls and floors, cabinets and counters were clean and sanitary throughout the home.
(Report continued on LIC809C.)
SUPERVISORS NAME: Lisa Hicks
LICENSING EVALUATOR NAME: Jewel Baptiste
LICENSING EVALUATOR SIGNATURE: DATE: 10/09/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/09/2023
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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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: DEL SOL HOME (ARTESIA)
FACILITY NUMBER: 306003743
VISIT DATE: 10/09/2023
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The outdoor grounds were toured and inspected, and the patio was well maintained with a shaded seating area accessible for client use. LPA also observed a shed that contained storage supplies. The garage contained a working washer and dryer, with cabinetry that contained bottled water, toiletries, personal care supplies, food, storage and toxins and cleaning agents stored locked and inaccessible to the clients.

Exit interview conducted with Mark De Ocampo, Administrator, a copy of this report was provided.
SUPERVISORS NAME: Lisa Hicks
LICENSING EVALUATOR NAME: Jewel Baptiste
LICENSING EVALUATOR SIGNATURE:

DATE: 10/09/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/09/2023
LIC809 (FAS) - (06/04)
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