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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306003743
Report Date: 10/28/2024
Date Signed: 10/28/2024 09:11:20 PM

Document Has Been Signed on 10/28/2024 09:11 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
GREATER LA AC/SC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754
FACILITY NAME:DEL SOL HOME (ARTESIA)FACILITY NUMBER:
306003743
ADMINISTRATOR/
DIRECTOR:
MERCI CANIA GONZALESFACILITY TYPE:
735
ADDRESS:12060 ARTESIA BLVD., EASTTELEPHONE:
(562) 860-1538
CITY:ARTESIASTATE: CAZIP CODE:
90701
CAPACITY: 4CENSUS: 4DATE:
10/28/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:20 AM
MET WITH:Maribel Sebastian, Co-AdministratorTIME VISIT/
INSPECTION COMPLETED:
01:45 PM
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Licensing Program Analyst (LPA) Cynthia Chan conducted the unannounced annual inspection on 10/28/24. LPA met with Co-Administrator, Maribel Sebastian, and explained the reason for the visit. The facility is licensed to serve 4 non-ambulatory developmentally disabled adults, ages 18 to 59. There is a hospice waiver approved for 1 client. There are currently 4 clients residing at the facility and are receiving services from the Harbor Regional Center.

LPA used the Compliance and Regulatory Enforcement (CARE) tools to conduct the inspection today.
The single story facility consists of 4 client bedrooms, 2 bathrooms, living room, dining area, kitchen, and attached garage. The facility continues to clean and sanitize daily and is well maintained. There is no swimming pool on the premises and no items are obstructing the walkways. The carbon monoxide detector and smoke detectors are operable. There are sufficient food supplies of 2 day perishable and a week of nonperishable. There is another refrigerator in the garage with food supplies. The hot water temperature was measured at 115.7 degree F. Knives and cleaning products are locked in the kitchen area. Medications are centrally stored. LPA reviewed all the clients' medications and did not observe any deficiencies.
LPA reviewed all 4 client files. The files have the required documents such as admission agreement, IPP report, medical assessment with TB results, personal rights form, and consent forms. The clients have restricted health conditions and staff receiving annual training on their health plans by a licensed professional. Those with postural supports have doctor's orders on file.
LPA selected 4 personnel files for review and all have the health assessment, TB results, personnel record, and current CPR & First Aid certificates. Administrator's (Merci Cania-Gonzales) certificate expires on 3/27/26. The facility has the updated Emergency Disaster Plan and conducts fire and earthquake drills monthly.

No deficiencies were issued today. An exit interview was held and a copy of this report was given to M. Sebastian.
SUPERVISORS NAME: Tony Vasallo
LICENSING EVALUATOR NAME: Cynthia D Chan
LICENSING EVALUATOR SIGNATURE: DATE: 10/28/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/28/2024
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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