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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306004383
Report Date: 10/21/2024
Date Signed: 10/21/2024 03:44:25 PM

Document Has Been Signed on 10/21/2024 03:44 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:SAN ANGELO HOMEFACILITY NUMBER:
306004383
ADMINISTRATOR/
DIRECTOR:		RIVAS, YANIRAFACILITY TYPE:
735
ADDRESS:16323 LAMBERT ROADTELEPHONE:
(562) 902-8429
CITY:WHITTIERSTATE: CAZIP CODE:
90604
CAPACITY: 6CENSUS: 6DATE:
10/21/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
02:23 PM
MET WITH:Elid Duran and Yanira Rivas, AdministratorTIME VISIT/
INSPECTION COMPLETED:
03:59 PM
NARRATIVE
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Licensee Program Analyst (LPA) Alberto Lopez made an unannounced visit to follow up Regional Center recommendations from May 2, 2024. LPA met with Elid Duran, Supervisor and discussed the purpose of the visit. Administrator Yanira Rivas arrived a short time later and assisted with the visit.

LPA observed the following during the visit today:

1) Medication Error that occurred on 05/02/2024. Staff signed off on medication without giving it.
Facility complied with recommendation that included sending an incident report and providing training to all staff. All staff received additional training on Medication Administration on May 9, 2024. Follow- up training was also provided on 10/19/2024 LPA obtained copies of certificates for all staff.

2) Reporting requirements. Staff did not report medication error until it
LPA obtained copies of training sign in sheet conducted on 05/24/2024

3) Physical Environment: Recommendations.

a) Paint client's closet door by near the floor.
LPA observed as completed.

b) Window screens in front of facility.
LPA observed as completed.

c) Window casting in front of facility.
LPA observed as completed.

d) Remove the lockable doorknob of the half door near the kitchen area,
LPA observed as completed. (continued on 809C)

)
SUPERVISORS NAME: Lisa Hicks
LICENSING EVALUATOR NAME: Alberto Lopez
LICENSING EVALUATOR SIGNATURE: DATE: 10/21/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/21/2024
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
GREATER LA AC/SC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754
FACILITY NAME: SAN ANGELO HOME
FACILITY NUMBER: 306004383
VISIT DATE: 10/21/2024
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(continued from 809)

As of LPA's visit on 10/21/2024 all Regional Center recommendations had been completed and LPA did not observed any deficiencies during visit.

LPA took tour of facility and did not observe any health and safety hazards.

Exit interview conducted and copy of report and appeal rights provided.
SUPERVISORS NAME: Lisa Hicks
LICENSING EVALUATOR NAME: Alberto Lopez
LICENSING EVALUATOR SIGNATURE:

DATE: 10/21/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/21/2024
LIC809 (FAS) - (06/04)
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