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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197801041
Report Date: 02/27/2023
Date Signed: 02/27/2023 02:58:29 PM

Document Has Been Signed on 02/27/2023 02:58 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:RNJ HOMES INCFACILITY NUMBER:
197801041
ADMINISTRATOR:ROBERTO CAMANOFACILITY TYPE:
740
ADDRESS:11416 TINA ST.TELEPHONE:
(562) 864-2078
CITY:NORWALKSTATE: CAZIP CODE:
90650
CAPACITY: 4CENSUS: 4DATE:
02/27/2023
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Administrator: ROBERTO CAMANOTIME COMPLETED:
03:00 PM
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Licensing Program Analyst (LPA) Ashley Calderon conducted an unannounced visit for the purpose of conducting the required annual inspection. On today's visit LPA met with Administrator, Robert Camano who assisted with the visit.

LPAs discussed and used the Inspection Tool -using the Infection control Domain with Mr. Carmano. LPA toured the facility home is a single story, 4 bedrooms, 2 restrooms, living room, kitchen,laundry area, dining room, and attached garage (used for storage).

Kitchen was clean, sharps were locked and stored, Lpa observed working appliances and had appropriate perishable and non-perishable food items for residents in care. Bedrooms have the required furniture including bedframes, dressers, lamps and chairs. Beds have the required linen and the linen is in good condition, clean and sanitary. Bathrooms were clean and had appropriate grab bars, non-skid mats, soap and hand towels. The front and backyard are well maintained, free of debris and has a shaded area for residents.The hot water temperature in residents restrooms ranged and measured between 105-120 F. The facility temperature at the time the visit was comfortable. There is sufficient lighting throughout the facility. There are smoke detectors located throughout the facility, tested and operational. Carbon monoxide detector was also observed in living room, tested and operational. Passageways and exits are free of obstruction.

(Continuation on 809-C...)
SUPERVISORS NAME: Fernando Fierros
LICENSING EVALUATOR NAME: Ashley Calderon
LICENSING EVALUATOR SIGNATURE: DATE: 02/27/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/27/2023
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, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754
FACILITY NAME: RNJ HOMES INC
FACILITY NUMBER: 197801041
VISIT DATE: 02/27/2023
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Residents are associated with Harbor Regional. Administrator Certificate #6008185740, Expires on 8/5/2024 . LPA reviewed In Service Training for Fire Drill conducted 2/3/23, done monthly. LPA Calderon reviewed along side with Roberto a total of four (4) resident medication and Medication Log, no deficiencies were observed. No Covid-19 at the above facility at this time, sufficient PPE for over 30 days plus, PPE located in the front of the facility, hand sanitizer available for residents, Covid log for residents observed.

Per California Code of Regulations, Title 22, and California Health and Safety Code, there were no deficiencies observed during the visit. Exit interview held and a copy of the report was provided to Mr. Camano
SUPERVISORS NAME: Fernando Fierros
LICENSING EVALUATOR NAME: Ashley Calderon
LICENSING EVALUATOR SIGNATURE:

DATE: 02/27/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/27/2023
LIC809 (FAS) - (06/04)
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