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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306004162
Report Date: 02/10/2022
Date Signed: 02/14/2022 12:26:13 PM

Document Has Been Signed on 02/14/2022 12:26 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 DR #100
MONTEREY PARK, CA 91754
FACILITY NAME:DE LEON HOMESFACILITY NUMBER:
306004162
ADMINISTRATOR:APRIL GORMANFACILITY TYPE:
735
ADDRESS:6100 E. WALTON STREETTELEPHONE:
(562) 354-6195
CITY:LONG BEACHSTATE: CAZIP CODE:
90815
CAPACITY: 4CENSUS: 2DATE:
02/10/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
02:00 PM
MET WITH:April GormanTIME COMPLETED:
04:00 PM
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On 02/10/22 Licensing Program Analyst (LPA) Jade Jordan conducted an unannounced Annual inspection to the facility, with an emphasis on inspection control. The LPA was met by Administrator April Gorman, and the purpose of the visit was explained. The facility is licensed to have four (4) Developmental disabled clients between the ages of 18-59 years of age. The facility is vendorized through Harbor Regional Center as a level 4G home. LPA reviewed staff and client records. All files reviewed were current and maintained the required documents. The Administrator certificate expires 10/21/22.

The home is a single story house which consists of : four (4) bedrooms, two (2) bathrooms, One (1) staff bedroom, kitchen, living room, dining area, covered patios and back yard and a attached garage used as a staff office. The washer and dryer are installed in the garage area. All client bedrooms were checked. Mattresses and box springs were in good condition, adequate lighting, plenty of dresser and closet space observed. Walls and floors were clean and in good condition. Bed linens, comforters and bath towels were adequately stocked at time of visit. Bathrooms were found to be within Title 22 regulation. Toilets and water facets worked properly. Showers were free of mold/mildew, adequate lighting, and sufficient toiletries accessible to consumers. Water temperature was measured at 107 degrees
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Perishable and non-perishable food supply was checked and adequately stocked at time of visit. Smoke detectors and carbon monoxide detector were working properly. Chemical and knifes were locked and inaccessible to clients. Medications were centrally stored and properly locked. Outside grounds were toured and no bodies of water were observed.
SUPERVISORS NAME: Michael Cava
LICENSING EVALUATOR NAME: Jade Jordan
LICENSING EVALUATOR SIGNATURE: DATE: 02/10/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/10/2022
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 DR #100
MONTEREY PARK, CA 91754
FACILITY NAME: DE LEON HOMES
FACILITY NUMBER: 306004162
VISIT DATE: 02/10/2022
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The facility is following their mitigation plan. LPA was screened for covid-19 symptoms, and temperature was
logged. Lpa observed a minimum of 30 day supply of PPE located in the garage. Available were gloves, gowns. face shields, N95's and surgical masks. No current Covid cases were present in the facility at the
time of LPA visit. Technical Advisory's were given Regarding N95 Fit testing, and LPA recommended,
new placement of isolation room. Signs regarding Covid-19 were visible posted indoor. Recommendation was made to have a more visible sign(s) posted outside of facility.

No citations issued during today's inspection visit.
SUPERVISORS NAME: Michael Cava
LICENSING EVALUATOR NAME: Jade Jordan
LICENSING EVALUATOR SIGNATURE:

DATE: 02/10/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/10/2022
LIC809 (FAS) - (06/04)
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