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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198603590
Report Date: 09/15/2022
Date Signed: 09/15/2022 11:22:56 AM

Document Has Been Signed on 09/15/2022 11:22 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:ALL FOR MOMS HOMECAREFACILITY NUMBER:
198603590
ADMINISTRATOR:TRUONG, PHUOCFACILITY TYPE:
740
ADDRESS:16136 E CLOVERMEAD ST.TELEPHONE:
(626) 456-1066
CITY:COVINASTATE: CAZIP CODE:
91722
CAPACITY: 6CENSUS: 0DATE:
09/15/2022
TYPE OF VISIT:Case Management - OtherANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Phuoc Truong (Henry), applicant/administratorTIME COMPLETED:
11:30 AM
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Licensing Program Analyst (LPA) Tao conducted an announced visit for pre-licensing follow up inspection. The applicant notified the department for visit since corrections were made. The initial pre-licensing visit was conducted on 09/08/2022. LPA met with Phuoc Truong (Henry), applicant/administrator, to discuss the purpose of today's visit and the inspection.

During this visit, LPA observed the following corrections were made:
1) Water Temperature: Tested at 114.0 degrees Fahrenheit
2) Resident records: Stored in a cabinet with a lock and inaccessible to residents
3) Alarm auditory devices at exits: all exits are installed with alarm auditory devices.
4) Resident bedrooms: Mattress pads are in place in all residents' beds
5) Resident bedrooms: A chair is available in each residents' room
6) Side gate exits: Side gate exits are self-closing and not locked.
7) Laundry room with cleaning compounds: Laundry room's door is installed a lock and inaccessible to residents.
8) Backyard: Water host is rolled and mounted on the wall.

Component III was conducted with applicant during the initial visit on 09/08/22. No further corrections are needed.

An Exit interview was completed with Administrator. A copy of this licensing report LIC 809, dated 09/15/2020, has been furnished to applicant. Applicant is advised to contact Centralized Application Bureau regarding the status of the application.
SUPERVISORS NAME: Fernando Fierros
LICENSING EVALUATOR NAME: Bonnie Tao
LICENSING EVALUATOR SIGNATURE: DATE: 09/15/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/15/2022
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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