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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306005938
Report Date: 05/17/2023
Date Signed: 05/17/2023 09:47:49 PM

Document Has Been Signed on 05/17/2023 09:47 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, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME:VIOLA HOMES ESTATEFACILITY NUMBER:
306005938
ADMINISTRATOR:DANIELA TILLESFACILITY TYPE:
735
ADDRESS:810 W. CIRCLE DRIVETELEPHONE:
(714) 867-7070
CITY:LA HABRASTATE: CAZIP CODE:
90631
CAPACITY: 4CENSUS: 1DATE:
05/17/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
08:30 AM
MET WITH:Erika PenaTIME COMPLETED:
11:30 AM
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On 05/16/2023. Licensing Program Analyst (LPA) Lydia Martinez made an attempted unannounced visit to the facility to conduct a Required -1 Year inspection. LPA rang the door bell several times and got no answer. LPA Martinez called and spoke to Licensee Miatta Snetter who stated staff is out taking client to Program and provided Administrator Gazel Montes' phone number. LPA called Administrator who stated she can contact House Manager to meet LPA but would take her an hour to arrive. LPA told AD she would conduct visit at a later date.
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On today's date, LPA Martinez made an unannounced visit to the facility to conduct the Required 1 Year inspection. LPA was greeted and granted entry by House Manager (HM) Erika Pena. LPA confirmed that Administrator Gazel M. Montes has a current Administrator certificate, which expires on 12/11/2024.
The facility currently has 1 client residing at the facility and 1 client who stated was only visiting for couple days present during today's visit. LPA Martinez, along HM Pena conducted a tour of the inside and outside of the facility. Facility is a one story, 4-bedroom, 3-bathroom home with detached garage that is being used for storage and kept locked. There is a back yard with a patio cover for the clients and a shed that is kept locked. Client bedrooms are spacious and accommodate lamps, chairs, bed, and dresser. Facility has no live in staff. There is one room used as an office. Bathrooms are clean, faucets and toilets are operational. Hot water temperature was measured and recorded at 140.8 and 142 degrees F in client bathrooms. Linens & Hygiene Supplies are fully stocked. Emergency Phone Numbers, Exit Plan & Menu were reviewed. Carbon Monoxide and Smoke Detectors were tested and operational. Fire Extinguisher is mounted, last charged on 11/21/2021. A 7 day nonperishable and 2-day perishable food supply reviewed. Stove burners, microwave, washer, and dryer inspected. Chemicals and sharps are made inaccessible to the clients. Medications are centrally stored in a locked medication cart. Medications reviewed appear to have been dispensed accurately.
SUPERVISORS NAME: Armando J Lucero
LICENSING EVALUATOR NAME: Lydia Martinez
LICENSING EVALUATOR SIGNATURE: DATE: 05/17/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/17/2023
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
CCLD Regional Office, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME: VIOLA HOMES ESTATE
FACILITY NUMBER: 306005938
VISIT DATE: 05/17/2023
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First-Aid Kit had all the required elements and Activity Supplies were observed and available. There is a working land line at the facility. Emergency drills are conducted monthly with the last emergency drill being conducted 05/01/2023 and documentation was available for review.

LPA reviewed one client file and one staff file. The client's P&I record was reviewed, LPA observed that an individual log is maintained for each client. All monies are accounted for and logs were kept to date.

In order to update CCL file, please provide the following updated documents to CCL by 05/25/2023: 1.) Designation of Administrative Responsibility (LIC308) 2.) Personnel Report (LIC500); 3.) Emergency Disaster Plan (LIC610D); 4.) Surety Bond; and 5.) Administrator certificate.



Based on the information received during this visit today in the areas reviewed, deficiencies are being cited per Title 22, Division 6 of The California Code of Regulations. Copy of this report will be sent to email on file.
SUPERVISORS NAME: Armando J Lucero
LICENSING EVALUATOR NAME: Lydia Martinez
LICENSING EVALUATOR SIGNATURE:

DATE: 05/17/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/17/2023
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Document Has Been Signed on 05/17/2023 09:47 PM - It Cannot Be Edited


Created By: Lydia Martinez On 05/17/2023 at 09:56 AM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868

FACILITY NAME: VIOLA HOMES ESTATE
FACILITY NUMBER: 306005938

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/17/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
80088(e)(1)
Hot water temperature controls shall be maintained to automatically regulate temperature of hot water delivered to plumbing fixtures used by clients to attain a hot water temperature of not less than 105 degrees F (40.5 degrees C) and not more than 120 degrees F (48.8 degrees C). This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, the licensee did not comply with the section cited above in 2 out of 3 restrooms water tested at 140 and 142 degrees F, which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 05/18/2023
Plan of Correction
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Facility to adjust the water heater to ensure the hot water temperature remains between 105 and 120 degrees F at all times. Facility to maintain a hot water temperature log for the next 10 days and submit to CCL on the 10th day via email or FAX.
Type A
Section Cited
CCR
80020(a)
FIRE CLEARANCE: (a) All facilities shall secure and maintain a fire clearance approved by the city or county fire department. This requirement was not met as evidenced by:
Deficient Practice Statement
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Based on observation, the Facility did not ensure the facility’s Fire Extinguisher is serviced annually, (last serviced on 11/21/2021, which poses an immediate health and safety risk to the persons in care.
POC Due Date: 05/18/2023
Plan of Correction
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Facility to have the Fire Extinguisher serviced or purchase new Fire Extinguishers and submit proof to LPA by POC due date of 05/18/2023
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Armando J Lucero
LICENSING EVALUATOR NAME:Lydia Martinez
LICENSING EVALUATOR SIGNATURE:
DATE: 05/17/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/17/2023


LIC809 (FAS) - (06/04)
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