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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198600256
Report Date: 10/03/2022
Date Signed: 10/03/2022 11:45:43 AM

Document Has Been Signed on 10/03/2022 11:45 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:HOME SWEET HOMEFACILITY NUMBER:
198600256
ADMINISTRATOR:CODRUTA PAULA VALEANUFACILITY TYPE:
740
ADDRESS:3342 COLD PLAINS DR.TELEPHONE:
(626) 333-4917
CITY:HACIENDA HEIGHTSSTATE: CAZIP CODE:
91745
CAPACITY: 5CENSUS: 3DATE:
10/03/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:CODRUTA PAULA VALEANU (Administrator)TIME COMPLETED:
12:00 PM
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 Licensing Program Analyst (LPA) Kruz Long conducted a site visit for the annual inspection. Upon arriving at the facility, LPA met with Codruta Paula Valenau (Administrator) and explained the purpose of the visit. FACILITY LICENSED TO SERVE ELDERLY RESIDENTS AGE 60 AND ABOVE. FIRE CLEARANCE GRANTED 4 NON-AMBULATORY AND 1 BEDRIDDEN. FACILITY IS 87724 COMPLIANT. FACILITY MAY RETAIN 3 HOSPICE RESIDENTS.

During today’s visit, LPA observed the following: Physical Plant and Environmental Safety: Sufficient lighting, non-skid maps in bathroom, comfortable temperature, hot water temperature measured between 105 degree F to 120 degree F in the bathroom, all bathing facilities in operable condition, no bodies of water on the premises, no firearms on the premises, toxins stored inaccessible to residents. Operational Requirements: Facility has an approved fire clearance for non-ambulatory persons and plan for dementia care. Staffing: There is sufficient staff, the administrator is on the premises during normal business hours. Personnel Records - Training: Staff has criminal record clearance, staff have sufficient hours of training. Resident Records/Incident Reports: Admission agreement, medical assessment and appraisal observed. Resident Rights/Information: Complaint poster (PUB 475) posted on wall next to the garage entrance, resident's personal rights in file. Planned Activities: Facility has sufficient space to accommodate indoor and outdoor activities, furnished areas is provided for relaxation of residents and entertaining friends and relatives. Food Services: Perishable foods are stored in covered containers, toxins are stored separate from foods, kitchen is kept clean. Resident with Special Health Needs: Hospice care plan is current, items that can constitute a danger is inaccessible to residents. Incidental Medical and Dental: Licensee provide assistance in meeting medical and dental needs for residents, all centrally stored medications is labeled and maintained in compliance with state and federal law. Disaster Preparedness: Fire safety plan and emergency exiting plan was observed. Resident roster, appraisal, contact information is readily available during emergencies.

No deficiencies were observed during today's visit.


Exit interview conducted with Codruta Paula Valenau and a copy of this report provided.
SUPERVISORS NAME: Fernando Fierros
LICENSING EVALUATOR NAME: Kruz Long
LICENSING EVALUATOR SIGNATURE: DATE: 10/03/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/03/2022
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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