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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306004036
Report Date: 01/17/2023
Date Signed: 01/17/2023 12:07:53 PM

Document Has Been Signed on 01/17/2023 12:07 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 (FAUST)FACILITY NUMBER:
306004036
ADMINISTRATOR:MERCI CANIA GONZALESFACILITY TYPE:
735
ADDRESS:6139 FAUST AVENUETELEPHONE:
(562) 804-2090
CITY:LAKEWOODSTATE: CAZIP CODE:
90713
CAPACITY: 4CENSUS: 3DATE:
01/17/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:15 AM
MET WITH:Jorgelle CatunaoTIME COMPLETED:
12:15 PM
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Licensing Program Analyst (LPA) Cynthia Chan conducted the required annual inspection with the focus of the Infection Control domain. LPA met with Co-Administrator, Jorgelle Catunao, and explained the purpose of the visit. The facility is approved for four (4) non-ambulatory developmentally disabled adults, ages 18 - 59 with restricted health conditions.

LPA Chan toured the facility and observed the following:
* There are 4 Client bedrooms, 1 Staff bedroom, 2 bathrooms, living room, kitchen, and an attached garage. There are no pool or bodies of water on the premises. There are no items obstructing the walkways or hallways. The spacious backyard has a shaded area for client use. The facility has proper Coronavirus (COVID-19) signage at the main entrance and around the home. Hand washing signs are posted in each of the bathrooms and kitchen sink. Staff are continuing to screen all visitors upon entry. Staff and Clients' temperature are also taken daily and documented. Sufficient PPE supplies are stored at the facility. The smoke detectors and carbon monoxide detector are operable. Food supplies are sufficient for one client who is able to consume food by mouth and the other clients with the restricted health conditions have at least a week of milk supplies. Knives and sharps are stored and locked in the kitchen area. Cleaning supplies are stored in the garage. Medications are centrally stored and locked in a cabinet. LPA reviewed 3 clients' medications and staff are administering them as prescribed by the physician. Emergency contact information for clients are most current and emergency contact numbers are posted. All staff on duty were wearing face masks. Staff are still following the strictest COVID-19 guidance and disinfecting all high touched surfaces at least once every shift. They have a backup plan to obtain more staff when needed.

No deficiencies were observed during the visit today. An exit interview was held and a copy of this report was provided to Co-Administrator.
SUPERVISORS NAME: Tony Vasallo
LICENSING EVALUATOR NAME: Cynthia D Chan
LICENSING EVALUATOR SIGNATURE: DATE: 01/17/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/17/2023
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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