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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197608094
Report Date: 12/09/2022
Date Signed: 12/09/2022 05:10:50 PM

Document Has Been Signed on 12/09/2022 05:10 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
GREATER LA AC/SC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754
FACILITY NAME:NARRA TREE INC/IBEX HOMEFACILITY NUMBER:
197608094
ADMINISTRATOR:MA. TERESA SANTOSFACILITY TYPE:
740
ADDRESS:18918 IBEX AVENUETELEPHONE:
(562) 860-1599
CITY:ARTESIASTATE: CAZIP CODE:
90701
CAPACITY: 6CENSUS: 4DATE:
12/09/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:30 PM
MET WITH:Teresa SantosTIME COMPLETED:
02:30 PM
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Licensing Program Analyst (LPA) Alma Gonzalez conducted an unannounced Annual Required / Infection Control visit to the above facility. LPA was met by Administrator Teresa Santos and the purpose of today’s visit was explained.

There are currently (4) clients in the facility. The facility is licensed to serve (6) developmentally disabled adults ages 18-59 years old, (2) ambulatory and (4) bedridden. Facility is operating within the approved capacity.

LPA and Administrator Teresa Santos toured the entire facility inside and out. The facility is a single story structure located in a residential neighborhood. Facility consists of the following: 4 Client bedrooms, 2 bathrooms, living room, kitchen with dining/ Office area, laundry room, outside/ patio covered area and an attached garage that is used as a storage area Bathrooms are clean and operational. Toilets and water faucets worked properly. Shower was free of mold/mildew, adequate lighting, and sufficient toiletries are accessible to clients. The facility was at a comfortable temperature. All client rooms that were inspected had the required furniture for comfort and safety such as bed frames, dressers, lamps and chairs and all had sufficient lighting. Clients beds have the required linen and the linen was in good condition at the time of the visit. All bedrooms had sufficient closet/ storage space. First aid kit is fully stocked with manual, smoke detectors and carbon monoxide detectors were in compliance and operational. No firearms are stored at facility and no bodies of water present. Medications are stored, locked and inaccessible to clients. Ample supply of perishable and nonperishable food, hot water temperature measured at 117 degrees Fahrenheit, personal hygiene supplies are adequate, hazardous toxins and/or items are inaccessible to clients, fire extinguisher is fully charged. Exit, walkways and/or passageways, front and back yard are free of debris and/or hazards. The facility is in good repair.

Report continues on LIC809C)

SUPERVISORS NAME: David Sicairos
LICENSING EVALUATOR NAME: Alma Gonzalez
LICENSING EVALUATOR SIGNATURE: DATE: 12/09/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/09/2022
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
GREATER LA AC/SC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754
FACILITY NAME: NARRA TREE INC/IBEX HOME
FACILITY NUMBER: 197608094
VISIT DATE: 12/09/2022
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The following were observed/inspected:
  • COVID-19 Infection Control Practices (including signs) were observed at the entrance of this facility, and in all common rooms bathrooms and hallways.
  • Clients are able to use their individual rooms as isolation rooms if a COVID-19 positive case should arise.
  • 30 day supply of medication for clients
  • Facility has an adequate amount of PPE and facility has enough PPE for 20 days.
  • Clients were socially distanced according to local public health guidelines.
  • Staff responsible for direct care and supervision were observed wearing masks.
  • Hand Sanitizer: Available throughout the facility for client use.
  • Clients temperature's are checked and logged three times a day.
  • Staff's temperature is checked and logged when beginning their shift.
  • Clients are tested weekly for COVID-19.
  • Staff are testing as needed if exhibiting any symptoms or exposure.
  • Staff and clients are all fully vaccinated with two boosters and the flu vaccine.


Exit interview conducted, a copy of this report was provided to Administrator Teresa Santos.
SUPERVISORS NAME: David Sicairos
LICENSING EVALUATOR NAME: Alma Gonzalez
LICENSING EVALUATOR SIGNATURE:

DATE: 12/09/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/09/2022
LIC809 (FAS) - (06/04)
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