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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197802778
Report Date: 10/12/2021
Date Signed: 10/12/2021 10:28:01 AM

Document Has Been Signed on 10/12/2021 10:28 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:ELLETT RESIDENTIAL FACILITYFACILITY NUMBER:
197802778
ADMINISTRATOR:ELLETT, LESTER WAYNEFACILITY TYPE:
735
ADDRESS:8242 CATALINA AVENUETELEPHONE:
(562) 789-0545
CITY:WHITTIERSTATE: CAZIP CODE:
90602
CAPACITY: 4CENSUS: 1DATE:
10/12/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:12 AM
MET WITH:Lester Ellet, AdministratorTIME COMPLETED:
10:35 AM
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Licensing Program Analyst (LPA) Galarza conducted an unannounced Required- 1 year visit focusing on COVID-19 Infection Control Practices. LPA met with staff Kathy Ellet and explained the purpose of the visit. Administrator Lester Ellett arrived shortly after. There is one (1) level 3 ambulatory developmentally disabled client in the home. The facility is a single story home licensed for 4 ambulatory clients located in a residential neighborhood. It consists of 3 client bedrooms, 1 staff bedroom, 3 bathrooms, dining room, kitchen, living room, den, outdoor patio and detached garage. The last fire drill was conducted on 10/3/2021. Administrator certificate expires March 24, 2023.

The following were observed/inspected:
  • The interior and exterior physical plant was inspected.
  • COVID-19 Infection Control Practices and signs were observed in the entrance, common areas, hallways, bathrooms and client rooms.
  • Signs are posted throughout the facility to promote hand washing, cough/sneeze etiquette, and physical distancing. Furniture was observed to be at least 6 feet apart.
  • Facility has two (2) designated isolation rooms.
  • One (1) centrally stored client medication record was reviewed.
  • Client and staff were observed wearing a masks.
  • Sufficient supply of perishable for 2 days & non-perishable foods for 7 days were observed.
  • A posted Emergency Disaster Plan was observed.
  • Sufficient supply of Personal Protective Equipment (PPEs) was observed.
  • Staff and resident files were not reviewed during today's visit.


There were no deficiencies cited.

Exit interview was conducted with Administrator Lester Ellett. A copy of the report was provided.
SUPERVISORS NAME: Lisa Hicks
LICENSING EVALUATOR NAME: Noemi Galarza
LICENSING EVALUATOR SIGNATURE: DATE: 10/12/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/12/2021
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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