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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306004383
Report Date: 11/03/2023
Date Signed: 11/05/2023 08:08:00 AM

Document Has Been Signed on 11/05/2023 08:08 AM - 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:SAN ANGELO HOMEFACILITY NUMBER:
306004383
ADMINISTRATOR:EVER RINCONFACILITY TYPE:
735
ADDRESS:16323 LAMBERT ROADTELEPHONE:
(562) 902-8429
CITY:WHITTIERSTATE: CAZIP CODE:
90604
CAPACITY: 6CENSUS: 6DATE:
11/03/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:30 PM
MET WITH:Yanira RivasTIME COMPLETED:
04:15 PM
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Licensing Program Analyst (LPA) Angelica Rea conducted an a site visit for the annual inspection. Upon arriving at the facility, LPA met with Yanira Rivas (Administrator) and explained the purpose of the visit.

The facility is located in a residential area. A tour of the single-story facility includes: Living room, attached garage/office/laundry, dining area, kitchen, 4 bedrooms and 2 bathrooms.

LPA Rea used the inspection tool, and toured the facility inside and out, reviewed food supply, reviewed resident and staff files, and reviewed resident medications. Bedrooms have the required furniture including bedframes, dressers, lamps and chairs. Beds have the required linen and the linen is in good condition. Passageways and exits are free of obstruction. The front and backyard are well maintained. The resident bathrooms are clean and have the required grab bars in the shower and near the toilet for non-ambulatory residents. Showers also have non-skid materials. The hot water temperature measured at 116 degrees F in Bathroom #1. The facility temperature at the time the visit was comfortable. There is sufficient lighting throughout the facility. There are smoke detectors/carbon monoxide detectors located throughout the facility, tested and operating. Knives and toxins are in locked cabinets, and inaccessible to residents. There is a sufficient amount of perishable and non perishable food supply. Medications reviewed, and appear to be given as prescribed. Administrator's certificate expires on 5/07/25. The facility held a fire drill on 11/1/23.

Per California Code of Regulations, Title 22, and California Health and Safety Code, no deficiencies cited. Exit interview held and a copy of the report provided to Ms. Rivas.
SUPERVISORS NAME: Lisa Hicks
LICENSING EVALUATOR NAME: Angelica Rea
LICENSING EVALUATOR SIGNATURE: DATE: 11/03/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/03/2023
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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