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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306005687
Report Date: 11/23/2022
Date Signed: 11/23/2022 10:12:13 AM

Document Has Been Signed on 11/23/2022 10:12 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, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME:SANTA VERONICA CARE VILLAFACILITY NUMBER:
306005687
ADMINISTRATOR:ALIPIO, IRENEO D JR.FACILITY TYPE:
735
ADDRESS:13332 LEE DRIVETELEPHONE:
(714) 606-1087
CITY:WESTMINSTERSTATE: CAZIP CODE:
92683
CAPACITY: 4CENSUS: 4DATE:
11/23/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
08:08 AM
MET WITH:Divina AlipioTIME COMPLETED:
10:31 AM
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Licensing Program Analyst (LPA) Joseph Alejandre made an unannounced visit to conduct the required annual inspection. LPA was screened for symptoms of Covid-19 and granted entry. LPA explained the reason for the visit. Administrator Divina Alipio Administrator's certificate expires 11/02/2023. LPA and staff toured the facility. Facility is a single story home with 4 bedrooms, 2 bathrooms, kitchen, living room, sun room (office) and a 2 car garage. LPA observed all client rooms were clean and organized had the required furnishings. LPA observed emergency food and water supply stored in a hall closet along with PPE supplies. LPA observed both bathrooms were clean and operational. Hot water measured 106.8 degrees Fahrenheit in bathroom one and 106.7 degrees Fahrenheit in bathroom two. LPA observed all medication is kept locked in the office. LPA inspected the first aid kit. The first aid kit had all the required elements. LPA observed a two day perishable and a seven day non-perishable food supply on hand in the kitchen. The kitchen is clean and organized. LPA observed the stove top lights unassisted. LPA observe knives are kept locked in a kitchen drawer. LPA observed cleaning supplies are kept locked under the kitchen sink. LPA and Administrator toured the garage. LPA observed the garage is kept locked and inaccessible to clients. The garage is used for storage. LPA and Administrator toured the backyard. LPA observed a table with an umbrella and chairs for clients to sit outside. The exit gates are operational. No bodies of water observed. No obstacles or hazards observed inside or outside of the facility. LPA consulted with the Administrator concerning continued Covid-19 mitigation and reporting requirements. No deficiencies observed. No deficiencies are being cited as a result of this visit. An exit interview was conducted and a copy of the report provided.
SUPERVISORS NAME: Luz Adams
LICENSING EVALUATOR NAME: Joseph Alejandre
LICENSING EVALUATOR SIGNATURE: DATE: 11/23/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/23/2022
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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