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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197606410
Report Date: 10/15/2024
Date Signed: 10/15/2024 02:47:45 PM

Document Has Been Signed on 10/15/2024 02:47 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, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754
FACILITY NAME:CARING PARTNERS, INCFACILITY NUMBER:
197606410
ADMINISTRATOR/
DIRECTOR:
TERESA SANTOSFACILITY TYPE:
740
ADDRESS:19607 WIERSMA AVENUETELEPHONE:
(562) 333-8141
CITY:CERRITOSSTATE: CAZIP CODE:
90703
CAPACITY: 6CENSUS: 4DATE:
10/15/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:18 PM
MET WITH:Administrator Nicholas FranciscoTIME VISIT/
INSPECTION COMPLETED:
03:01 PM
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On 10/15/24, Licensing Program Analyst (LPA) Jewel Baptiste conducted an unannounced Annual/Required inspection to Caring Partners Inc. Upon arrival LPA was greeted by the Administrator Nicholas Francisco and LPA explained the reason for the visit. This home is licensed to serve (6) residents. The facility is approved to have (4) non-Ambulatory and (2) Ambulatory residents aged 60 and above. The home is vendorized through Harbor Regional Center. There were (2) residents in care during the time of this visit. The last emergency disaster/fire drill was conducted on 10/02/2024. The Administrator Certificate expires on 9/08/2026 #6046598740. During today's visit LPA inspected the physical plant inside and outside, reviewed the food supply, tested the smoke/carbon monoxide detectors, reviewed (3) staff files, (3) resident files, medications, and medication administration records for (3) residents and P&I.

This home contains 4 bedrooms, 3 bathrooms, living room, Family room with covered fireplace, kitchen, dining room and an attached garage. LPA toured the physical plant with the Administrator and observed all (4) resident bedrooms, contained required furniture, lamps, dresser, chair, and closet space. Resident #1 bedroom had a hole from door handle. The three bathrooms contain a working toilet, basin, and water faucet, walk in shower with grab bar, shower chair, bathmat or nonskid material. Bathroom 3# was missing shower head and had a small hole. The temperature measured at 114.4 – 117.3 degrees F. The smoke detectors were battery operated, tested and observed to be working properly. The carbon monoxide detector was located in the kitchen, tested, and functioning properly. There were (2) fire extinguisher located in kitchen and garage, fully charged and up to date. The kitchen was toured and contained working appliances; refrigerator, stove, oven and contained dishware, cups, plates, utensils, pots, and pans. The knives were secured in a kitchen cabinet. The cleaning agents and toxins was locked underneath the kitchen sink. The pantry was well stocked with canned goods, pasta, cereals, and the food supply contained a sufficient supply with a two-day supply of perishables and a seven-day supply of non-perishables that met title 22 guidelines. Walls and floors, cabinets and counters were clean and sanitary throughout the home. (Report continued on LIC809C.)
SUPERVISORS NAME: Lisa Hicks
LICENSING EVALUATOR NAME: Jewel Baptiste
LICENSING EVALUATOR SIGNATURE: DATE: 10/15/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/15/2024
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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Document Has Been Signed on 10/15/2024 02:47 PM - It Cannot Be Edited


Created By: Jewel Baptiste On 10/15/2024 at 02:20 PM
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
, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754

FACILITY NAME: CARING PARTNERS, INC

FACILITY NUMBER: 197606410

DEFICIENCY INFORMATION FOR THIS PAGE:

VISIT DATE: 10/15/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
87307(d)(2)
Personal Accommodations and Services
(2) The premises shall be maintained in a state of good repair and shall provide a safe and healthful environment.

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 which bedroom #1 had a hole and bathroom #3 was missing shower head and had a hole, which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 10/29/2024
Plan of Correction
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The Administrator will ensure the facility is in good repair at all times. Photo proof is due to LPA by POC due date.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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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:Lisa Hicks
LICENSING EVALUATOR NAME:Jewel Baptiste
LICENSING EVALUATOR SIGNATURE:
DATE: 10/15/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/15/2024


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, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754
FACILITY NAME: CARING PARTNERS, INC
FACILITY NUMBER: 197606410
VISIT DATE: 10/15/2024
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The outdoor grounds were toured and inspected, and the patio was well maintained with a shaded seating area accessible for resident use. The garage contained a working washer and dryer, extra food, storage supplies and PPE supplies.

Exit interview conducted with Nicholas Francisco, Administrator, a copy of this report and appeals rights was provided via email.
SUPERVISORS NAME: Lisa Hicks
LICENSING EVALUATOR NAME: Jewel Baptiste
LICENSING EVALUATOR SIGNATURE:

DATE: 10/15/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/15/2024
LIC809 (FAS) - (06/04)
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