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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198603568
Report Date: 07/25/2024
Date Signed: 07/25/2024 03:32:52 PM

Document Has Been Signed on 07/25/2024 03:32 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 HOME VFACILITY NUMBER:
198603568
ADMINISTRATOR/
DIRECTOR:		TRICE, THOMASFACILITY TYPE:
740
ADDRESS:14402 HELWIG AVENUETELEPHONE:
(562) 397-2591
CITY:NORWALKSTATE: CAZIP CODE:
90650
CAPACITY: 6CENSUS: 6DATE:
07/25/2024
TYPE OF VISIT:Case Management - Annual ContinuationUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:40 PM
MET WITH:Administrator Thomas Trice TIME VISIT/
INSPECTION COMPLETED:
03:40 PM
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Licensing Program Analyst (LPA) Jose Villalobos conducted an unannounced Required- 1 year visit to continue and complete using the full Care Compliance and Regulatory Enforcement (CARE) Tools. LPA met with Administrator Thomas Trice and the purpose of the visit was discussed.

The inspection was conducted to completed the remaining (6) domains of the CARE tools:

Infection Control: Infection control practices and Personal Protective Equipment (PPEs) were observed. Visitors are no longer screened for COVID-19 or required to sign in. The facility has an Infection Control Plan and COVID-19 Mitigation Plan.

Operational Requirements: The facility has a Dementia Waiver in place. A Hospice Waiver for 4 is approved. A fire clearance for 6 non-ambulatory adults 60 and over; of which one (1) may be bedridden in room 3 only. Required Liability Insurance is in place. A surety bond is not applicable. Facility does not handle resident's money.



Incident Medical and Dental: LPA reviewed medications for (6) Residents. 30-day supply of resident medications were observed. Centrally Stored Records for medications are kept. Medication stored matches the medication record for each resident. Medical and dental transportation is provided by family members.

Residents with Special Health Needs: Four (4) residents receive home health services. Postural support observed for one resident. Physician order is on file. Two (2) residents had full rails. Both residents are on Hospice. Total of (2) Residents are on hospice. No residents have prohibited health conditions.

Staffing: Sufficient caregiver staff provide care and supervision to the clients.

Personnel Records/Staff Training: Administrator certificate expires 12/1/2024. Personnel files were reviewed. LPA reviewed a total of (5) Staff fIles including the administrator. LPA observed required documents for each.Proof of staff training was reviewed. Current 1st Aid/CPR records are current.

No deficiencies are being cited on todays visit. Exit interview conducted and copy of this report was provided.

SUPERVISORS NAME: Fernando Fierros
LICENSING EVALUATOR NAME: Jose Villalobos
LICENSING EVALUATOR SIGNATURE: DATE: 07/25/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/25/2024
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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