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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306004224
Report Date: 11/12/2023
Date Signed: 11/12/2023 12:15:02 PM

Document Has Been Signed on 11/12/2023 12:15 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
EL SEGUNDO, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754
FACILITY NAME:CAMERON HOMEFACILITY NUMBER:
306004224
ADMINISTRATOR:RONNELL L. AGLIAMFACILITY TYPE:
735
ADDRESS:2225 W. CAMERON STREETTELEPHONE:
(562) 424-4450
CITY:LONG BEACHSTATE: CAZIP CODE:
90810
CAPACITY: 3CENSUS: 3DATE:
11/12/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Ronnel L AgliamTIME COMPLETED:
12:11 PM
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On 11/12/23, Licensing Program Analyst (LPA) Ernand Dabuet conducted an unannounced annual required visit using the CARE Inspection Tool. LPA met with the administrator Ronnel Agliam. LPA explained the purpose of today’s visit. The facility is licensed to operate for three(3) developmentally disabled adults with restricted health conditions ages 18 through 59. One (1) ambulatory and two (2) non-ambulatory. The clients are Harbor Regional Center consumers.

The facility is a single-story structure located in a residential neighborhood. It consists of the following: three (3) clients' rooms, three (3) bathrooms, a living area, a dining area, a kitchen, and an outside patio area.

LPA toured the physical plant. There were no bodies of water or obstructions on the premises. All rooms were inspected. Beds and bedding supplies were in good condition, adequate lighting was provided, and storage for the client's personal belongings was observed. Bed linens, comforters, and bath towels were adequately stocked at the time of the visit. Bathrooms were found to be within Title 22 regulations and were clean and operational. A comfortable temperature of 75 degrees was maintained in the facility. Hot water temperature measured at 106.7 degree F.

LPA observed the facility to be sanitary and appropriately furnished during the visit. Storage areas for personal hygiene, cleaning supplies, toxins, and sharps objects were stored and not accessible to clients. The kitchen was inspected and there is sufficient perishable and non-perishable food available and maintained adequately. A fire extinguisher was charged, and smoke detectors and carbon monoxide were operable. A review of Medication Records Administration (MAR) and Fire Drills were observed to be maintained in order and accurately. The facility conducted Fire/Safety Drill on 08/23/23. The facility has a working landline telephone available.

Evaluation Report Continues on LIC 809-C
SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Ernand Dabuet
LICENSING EVALUATOR SIGNATURE: DATE: 11/12/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/12/2023
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754
FACILITY NAME: CAMERON HOME
FACILITY NUMBER: 306004224
VISIT DATE: 11/12/2023
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During the visit, LPA observed the facility's infection control practices. LPA observed screening protocols for visitors, staff, and residents, and sanitizing stations in common areas and restrooms. LPA observed the facility has a 30-day supply of Personal Protective Equipment (PPE). All mandated inspection control posters were posted. A review of staff and client files were found to be maintained in order and accurately.

An audit review of client #1-#3 (C1-C3) files and staff #1-#5 (S1-S5) personnel files. The facility is current on CCL license annual fees. The facility handles P&I finances for clients revealed records to be in order and complete. The facility is current on CCL annual dues. The facility has the current administrator's certification on file for Ronnel Agliam expiration date 03/10/24 #6010967735. and Annabelle Agliam expiration date 03/08/25 #6024443735.

No deficiencies cited during this inspection visit.

An exit interview was conducted and a copy of this report and appeal rights were provided to Ronnel Agliam.
SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Ernand Dabuet
LICENSING EVALUATOR SIGNATURE:

DATE: 11/12/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/12/2023
LIC809 (FAS) - (06/04)
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