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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198603572
Report Date: 10/06/2023
Date Signed: 10/06/2023 01:58:05 PM

Document Has Been Signed on 10/06/2023 01:58 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:PALAZZO OF DOWNEY, INC., THEFACILITY NUMBER:
198603572
ADMINISTRATOR:CARRILLO, ROWENA MARANTALFACILITY TYPE:
740
ADDRESS:9276 DOWNEY AVETELEPHONE:
(562) 659-7586
CITY:DOWNEYSTATE: CAZIP CODE:
90240
CAPACITY: 6CENSUS: 2DATE:
10/06/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:29 AM
MET WITH:Administrator Rowena MarantalTIME COMPLETED:
02:10 PM
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On 10/06/23 at 10:30 a.m., Licensing Program Analyst (LPA) Jewel Baptiste conducted an unannounced Annual/Required inspection to Palazzo of Downey, Inc., The. Upon arrival LPA was greeted by the administrator Rowena Marantal and LPA explained the reason for the visit. This home is licensed to serve age range 60 and over. Fire clearance approved for six (6) ambulatories. Licensed is subject to terms and conditions for hospice waiver approved for four (4) residents. No dementia residents. There were two (2) residents in care at the time of the visit. The last emergency disaster drill conducted on 6/27/2023. The Administrator Certificate expires on 6/24/2023 #6004604740. LPA confirmed administrator certificate is pending on CCLD website. During today's visit LPA inspected the physical plant inside and outside, reviewed the food supply, tested the smoke/carbon monoxide detectors, reviewed (1) staff files, (2) resident files, medications, and medication administration records for (2) residents.

This facility is a two (2) story home in a residential area. The first floor contains 2 bedrooms, 1.5 bathrooms, 2 living rooms, 2 dining room, laundry, kitchen, dining room and an attached garage. The second floor consists of 3 vacant bedrooms, 1 staff bedroom, 3 bathrooms, sitting area, and 1 dinning room. The facility also contains a maid’s quarter with 2 bedrooms,1 bathroom, and 1 living room with fireplace. The maid’s quarters are currently designated for the licensee’s kids aged 15 and 17. LPA toured the physical plant with the Administrator and observed all resident bedrooms, contained required furniture, lamps, dresser, chair, and closet space. The bathrooms contained a working toilet, basin and water faucet, shower with grab bars, shower chair, and bath/ skid mat. The water temperature was measured at 105.0*F-109.5*F respectively. The smoke detectors were tested and observed to be working properly. The carbon monoxide detector was located throughout the facility, tested, and functioning properly. There were (2) fire extinguishers located in kitchen and the upstairs dining room fully charged and up to date. The kitchen was toured and contained working appliances; refrigerator, stove, oven and contained dishware, cups, plates, utensils, pots, and pans with knives secured in the kitchen draw and the cleaning agents and toxins was locked underneath kitchen sink and in the laundry room. The pantry was well stocked with canned goods, pasta, cereals, and the food supply contained a sufficient supply with a two-day supply of perishables and a seven-day supply of non-perishables that met title 22 guidelines. Walls and floors, cabinets and counters were clean and sanitary throughout the home. (Report continued on LIC809C.)
SUPERVISORS NAME: Lisa Hicks
LICENSING EVALUATOR NAME: Jewel Baptiste
LICENSING EVALUATOR SIGNATURE: DATE: 10/06/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/06/2023
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: PALAZZO OF DOWNEY, INC., THE
FACILITY NUMBER: 198603572
VISIT DATE: 10/06/2023
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The outdoor grounds were toured and inspected, and the patio was well maintained with a shaded seating area accessible for resident use. The garage contained storage supplies. The laundry room contained laundry supplies, towels, PPE’s, cleaning agents and staff fridge.

Exit interview conducted with Rowena Marantal, Administrator, a copy of this report was provided.
SUPERVISORS NAME: Lisa Hicks
LICENSING EVALUATOR NAME: Jewel Baptiste
LICENSING EVALUATOR SIGNATURE:

DATE: 10/06/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/06/2023
LIC809 (FAS) - (06/04)
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