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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306004018
Report Date: 02/24/2022
Date Signed: 02/24/2022 12:53:31 PM


Document Has Been Signed on 02/24/2022 12:53 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:REM CALIFORNIA, LLC - BELLFLOWERFACILITY NUMBER:
306004018
ADMINISTRATOR:MANALASTAS, ALBERTOFACILITY TYPE:
735
ADDRESS:6129 BELLFLOWER BLVDTELEPHONE:
(562) 866-9634
CITY:LAKEWOODSTATE: CAZIP CODE:
90713
CAPACITY:4CENSUS: 4DATE:
02/24/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:15 AM
MET WITH:Alberto Manalastas - AdministratorTIME COMPLETED:
01:15 PM
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Licensing Program Analyst (LPA) Luis Mora conducted an unannounced annual visit at the facility with focus on the infection control domain, medication and food review. LPA Mora met with Program Supervisor Marcus Rucker and explained the reason for the visit. The Administrator Alberto Manalastas arrived shortly after. The facility is licensed to serve 3 ambulatory and 1 non-ambulatory developmentally disabled clients ages 18 to 59 years old. The facility is in a residential area. A tour of the single-story facility included: living room, kitchen, 4 client bedrooms, 2 bathrooms, laundry area, staff office, detached garage, front yard, and backyard.

LPA Mora conducted the tour with Marcus Rucker and observed the following: sufficient food supplies for at least 2 days of perishables and 7 days of non-perishables were observed in the kitchen and in the refrigerators located in the garage. Sharps and First Aid kit were observed locked in a cabinet located in the kitchen and chemical solutions were locked under the kitchen's sink. The First Aid kit was fully stocked with all required items including a current manual. There is a closet in the hallway with clean towels and extra linen. Dining and living room have sufficient lighting and sitting area. Medication cabinet was observed locked in the kitchen. All bedrooms have all required furniture, lighting, and bedding. Both bathrooms were observed with shower mats and water temperature was tested at 106.7 degrees F, which is within the required 105-120 degrees F. Fire extinguishers were observed in the laundry area and kitchen, and fully charged. Smoke detectors were observed throughout the facility and in each room, and were operable during the visit. Carbon monoxides were observed in the kitchen, hallway and laundry area, and were operable during the visit. The front yard and backyard are clean, and there is a shaded sitting area in the backyard. No bodies of water were observed at the facility. Passageways and exits are free of obstruction. LPA reviewed 2 client medications and files. Medications are documented properly and given as prescribed. Client files are complete and updated. LPA reviewed 3 staff files. Staff files are complete and updated. LPA observed administrator certificate for Alberto Manalastas #6050299735 with an expiration date of 05/20/2022.
(CONTINUED TO LIC 809C)
SUPERVISOR'S NAME: Stefanie CoronelTELEPHONE: (323) 981-3961
LICENSING EVALUATOR NAME: Luis MoraTELEPHONE: 323-981-3964
LICENSING EVALUATOR SIGNATURE:
DATE: 02/24/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/24/2022
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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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: REM CALIFORNIA, LLC - BELLFLOWER
FACILITY NUMBER: 306004018
VISIT DATE: 02/24/2022
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Facility has 30 days supplies of Personal Protective Equipment in the staff office. Facility is following COVID-19 recommendations regarding screening visitors, staff, and clients. Signs are posted throughout the facility and hand-washing signs were observed in the bathrooms. Sufficient hand soap, hand sanitizer, and paper towels were observed.

Per California Code of Regulations, Title 22, and California Health and Safety Code, there were no deficiencies observed during the visit. Exit interview held and a copy of the report was provided.
SUPERVISOR'S NAME: Stefanie CoronelTELEPHONE: (323) 981-3961
LICENSING EVALUATOR NAME: Luis MoraTELEPHONE: 323-981-3964
LICENSING EVALUATOR SIGNATURE:

DATE: 02/24/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/24/2022
LIC809 (FAS) - (06/04)
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