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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306004423
Report Date: 10/18/2021
Date Signed: 10/18/2021 04:55:49 PM

Document Has Been Signed on 10/18/2021 04:55 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 CNTR DR. ST 500
MONTEREY PARK, CA 91754
FACILITY NAME:ELWYN NC - LARRYLYNFACILITY NUMBER:
306004423
ADMINISTRATOR:TERESA OPORTOFACILITY TYPE:
735
ADDRESS:10915 LARRYLYN DRTELEPHONE:
(562) 315-5505
CITY:WHITTIERSTATE: CAZIP CODE:
90603
CAPACITY: 4CENSUS: 4DATE:
10/18/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:50 AM
MET WITH:Eva GallardoTIME COMPLETED:
12:30 PM
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Licensing Program Analyst (LPA) Jose Villalobos made and unannounced Annual inspection focused on Infection Control. On today’s visit LPA met with facility Staff Eva Gallardo and the purpose of the visit was discussed. As a part of the inspection, LPA used the inspection tool, reviewed client records, staff records, medications.

LPA toured the facility between 10:30am-11am. This is a single story home consisting of: kitchen , dinning room, living rooms, four (4) bedrooms, two (2) bathrooms, and an attached garage. The home is vendorized through the East Los Angeles Regional Center and is designated as a Level 4 facility. LPA toured the physical plant between 10:15am-10:45am. The following was observed. In the bedrooms, mattresses and box springs were in good condition, adequate lighting, plenty of dresser and closet space was observed. Walls and floors were clean and in good repair. Bed linens, comforters and bath towels were adequately stocked at the time of visit. Bathrooms were found to be within Title 22 regulation. Toilets and water faucets worked properly. Water temperature properly measured between 105*-120F*. LPA reviewed files for (4) of (4) clients and (4)Staff between 10:45am-11:30am. Perishable and non-perishable food supply was checked and adequately stocked at time of visit. Carbon monoxide detector and smoke detectors are operational. Fire extinguishers were fully charged and operational, toxins and knifes were locked and inaccessible to clients. Medications were centrally stored and properly locked, first aid kit was checked an in order. Outside grounds were toured and no bodies of water were observed. Patio furniture with shade was accessible. Exits/ Walkways around the home were free of debris and hazards. LPA completed visit with the Inspection Tool focused on Infection Control.

No deficiencies cited on this visit and a copy of report was furnished

SUPERVISORS NAME: Fernando Fierros
LICENSING EVALUATOR NAME: Jose Villalobos
LICENSING EVALUATOR SIGNATURE: DATE: 10/18/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/18/2021
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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