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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198603242
Report Date: 12/10/2021
Date Signed: 12/13/2021 08:58:23 PM

Document Has Been Signed on 12/13/2021 08:58 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:EUROPEAN CHRISTIAN HOMEFACILITY NUMBER:
198603242
ADMINISTRATOR:TRICE, THOMASFACILITY TYPE:
740
ADDRESS:9249 DALBERG STREETTELEPHONE:
(562) 397-2591
CITY:BELLFLOWERSTATE: CAZIP CODE:
90706
CAPACITY: 6CENSUS: 5DATE:
12/10/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:31 AM
MET WITH:Thomas TriceTIME COMPLETED:
01:30 PM
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Licensing Program Analyst(LPA) Nicol Wesley conducted an unannounced required 1 year visit and met with Administrator Thomas Trice and explained the purpose for todays visit. Prior to the visit LPA Wesley conducted a risk assessment for on-site inspections. The facility phone number is 562 633 1285.

The facility consist of 6 bedroom (5 for residents and 1 for staff) and 2 bathrooms(1 bathroom for staff and 1 bathroom for residents), a living room, dining room, kitchen, family room, back yard with an area for shade, and an unattached garage.

During the visit the Infection control domain was used and the following areas were observed/inspected: The facility had all postings at the front entrance, bathrooms, and throughout the facility. A Pre screening area with PPE supplies was observed upon entry into the facility. The Administrator advised that a facility mitigation plan was submitted to the department.

LPA conducted a complete tour of the facility, and observe the supply of food. Resident medications, and medication logs were reviewed. The smoke detectors/carbon monoxide detector are operable. LPA observed one fire extinguisher in the living room area next to the kitchen. The water temperature was tested and measured at 114 degrees F. LPA Wesley received a copy of the facility mitigation plan report at the time of visit.

Administrators certificate for Thomas Trice #6048147740, expires on 12/01/2022.

There were no deficiencies cited.

Exit interview conducted.
SUPERVISORS NAME: Rebecca Orendain
LICENSING EVALUATOR NAME: Nicol Wesley
LICENSING EVALUATOR SIGNATURE: DATE: 12/10/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/10/2021
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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