<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306004036
Report Date: 01/24/2025
Date Signed: 01/24/2025 12:23:36 PM

Document Has Been Signed on 01/24/2025 12:23 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
MONTEREY PARK ASC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754
FACILITY NAME:DEL SOL HOME (FAUST)FACILITY NUMBER:
306004036
ADMINISTRATOR/
DIRECTOR:		MERCI CANIA GONZALESFACILITY TYPE:
735
ADDRESS:6139 FAUST AVENUETELEPHONE:
(562) 804-2090
CITY:LAKEWOODSTATE: CAZIP CODE:
90713
CAPACITY: 4CENSUS: 4DATE:
01/24/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:00 AM
MET WITH:Francisco Calero (Caregiver)TIME VISIT/
INSPECTION COMPLETED:
12:30 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
Licensing Program Analysts (LPA) Luis DeLeon and Myra Cota conducted an unannounced annual visit using the CARE Tool. LPA met with Francisco Calero (Caregiver) and explained the reason for the visit. Francisco Calero called administrator to inform of visit. Co-Administrator Jorgellean Catunao arrived a little time after. In addition, Maribel Sebastian joined the visit and identified herself as another Co-Administrator.

The facility is licensed to serve 4 non-ambulatory developmentally disabled adults ages 18 to 59 years old with restricted health conditions. The facility is operating within the scope of its license.

LPA and Administrator toured the home and inspected 4 client bedrooms, 1 staff room, 2 client/staff full bathrooms, kitchen, dining area, living room, front yard, backyard, and attached garage.
  • The front and backyard are well maintained and there are no pools or large bodies of water. There is a shaded seating area for the clients located in the backyard.
  • Passageways and exits are free of obstruction.
  • The water temperature was tested in both bathrooms and measured at 117.6 degrees F for bathroom 1 and 116.5 degrees F for bathroom 2 which is within the required 105 - 120 degrees.
  • Client bedrooms have the required furniture such as bed frames, dressers, lamps, and chairs. Bedrooms also have sufficient closet space. Client beds have the required linen, and the linen is in good condition. There is a closet in the hallway with extra clean linen and towels.
  • Smoke detectors were observed in each room and throughout the facility and are properly operating.
  • There is a carbon monoxide detector in the hallway, and it is properly operating. There is one fire extinguisher located in the kitchen which is fully charged.


Report continues on 809-c.
SUPERVISORS NAME: Fernando Fierros
LICENSING EVALUATOR NAME: Luis DeLeon
LICENSING EVALUATOR SIGNATURE: DATE: 01/24/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/24/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 3
Document Has Been Signed on 01/24/2025 12:23 PM - It Cannot Be Edited


Created By: Luis DeLeon On 01/24/2025 at 11:40 AM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754

FACILITY NAME: DEL SOL HOME (FAUST)
FACILITY NUMBER: 306004036

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/24/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
80075(b)(5)(B)
Health-Related Services
(b) Clients shall be assisted as needed with self-administration of prescription and nonprescription medications. (5) If the client's physician has stated in writing that the client is unable to determine his/her own need for nonprescription PRN medication, but can communicate his/her symptoms clearly, facility staff designated by the licensee shall be permitted to assist the client with self-administration, provided all of the following requirements are met: (B) Once ordered by the physician the medication is given according to the physician's directions.

This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on LPAs observations and medication review, medication for january 21, 2025 was not popped and administered to client as prescribed by physcian. However, MAR log indicated that dosage was administered as indicated by staff initial on january 21st which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 01/25/2025
Plan of Correction
1
2
3
4
Licensee will hold a training session with all staff on proper medication administration and documentation. Licensee will provide LPA with proof of training for all staff including date and time.
Section Cited
Deficient Practice Statement
1
2
3
4
POC Due Date:
Plan of Correction
1
2
3
4
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:Fernando Fierros
LICENSING EVALUATOR NAME:Luis DeLeon
LICENSING EVALUATOR SIGNATURE:
DATE: 01/24/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/24/2025


LIC809 (FAS) - (06/04)
Page: 2 of 3
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK ASC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754
FACILITY NAME: DEL SOL HOME (FAUST)
FACILITY NUMBER: 306004036
VISIT DATE: 01/24/2025
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
  • Kitchen appliances are clean and were operating at the time of the visit. Sharps are locked in a cabinet in the kitchen and are inaccessible to clients.
  • Cleaning supplies and toxins are locked in a cabinet inside the garage and are inaccessible to clients.
  • Sufficient supply of 2 days perishable & 7 days non-perishable foods was observed in the kitchen and garage.
  • Client medications and files are centrally stored in a locked cabinet in the dining area. Staff files are kept locked in a file cabinet in the dining area.
  • All four of the client files and medications were reviewed. LPAs observed during medication review that client #3’s (C3) Medication pills had not been popped for January 21st as prescribed by physician.
  • Five staff files were reviewed, and no deficiencies were found.

Per California Code of Regulations, Title 22, and California Health and Safety Code, there was a deficiency observed and noted during the visit. Exit interview held and a copy of the report was provided. In addition, appeals rights were also printed and provided to administrator at the time of visit.
SUPERVISORS NAME: Fernando Fierros
LICENSING EVALUATOR NAME: Luis DeLeon
LICENSING EVALUATOR SIGNATURE:

DATE: 01/24/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/24/2025
LIC809 (FAS) - (06/04)
Page: 3 of 3