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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198603577
Report Date: 09/23/2022
Date Signed: 09/23/2022 02:05:20 PM

Document Has Been Signed on 09/23/2022 02:05 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:DELTA HOME CARE IIIFACILITY NUMBER:
198603577
ADMINISTRATOR:KUNKEL, MARIEFACILITY TYPE:
740
ADDRESS:2400 ANGELA ST.TELEPHONE:
(626) 912-3454
CITY:WEST COVINASTATE: CAZIP CODE:
91792
CAPACITY: 4CENSUS: 4DATE:
09/23/2022
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
09:19 AM
MET WITH:Marie Kunkel, Administrator TIME COMPLETED:
10:00 AM
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Licensing Program Analyst (LPA) Galarza conducted a follow-up Prelicensing visit to verify corrections. The purpose of the visit was explained to Administrator Marie Kunkel. An initial Prelicensing visit was conducted on 8/31/2022. The facility presently has four (4) non-ambulatory developmentally disabled adults.

The items listed below have been corrected:
  • The hot water temperature in kitchen and bathrooms measured within normal limits 105 degrees Fahrenheit (40.5 degrees C) and not more than 120 degrees Fahrenheit (48.8 degrees C).
  • The side iron gates locking mechanisms have been removed.
  • The facility purchased a new stove and all burners are operational.


An exit interview was conducted, and a copy of this report has been furnished to Administrator Marie Kunkel. Accordingly, LPA will submit a copy of this facility evaluation report to the Central Applications Bureau (CAB) for review. If the applicant has questions regarding the status of the application, they have been instructed to communicate with the CAB Analyst assigned to their application.
SUPERVISORS NAME: Lisa Hicks
LICENSING EVALUATOR NAME: Noemi Galarza
LICENSING EVALUATOR SIGNATURE: DATE: 09/23/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/23/2022
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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