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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198603590
Report Date: 09/21/2023
Date Signed: 09/21/2023 12:27:32 PM

Document Has Been Signed on 09/21/2023 12:27 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: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: 6DATE:
09/21/2023
TYPE OF VISIT:Case Management - Annual ContinuationUNANNOUNCEDTIME BEGAN:
08:11 AM
MET WITH:Phuoc Truong (Henry), applicant/administratorTIME COMPLETED:
12:45 PM
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Licensing Program Analysts (LPA) Tao conducted an unannounced subsequent visit to the facility for purpose of an annual continuation inspection. LPA met with Phuoc Truong, administrator, who assisted with the visit. The facility is licensed to serve Residential Care Elderly to serve elderly, ages 60 years old and older, and has dementia program.

Today's annual inspection, LPA completed the domains in CARE tools which were pending from 9/11/23 visit, conducted staff/residents file reviews and medication reviews.

Medications were centrally stored, locked and the records were current. Staff / residents' records were stored in a locked cabinet and the section has been inspected along with the available records present.

No deficiencies were cited per California Code of Regulations, Title 22.



Exit conference was conducted with administrator. This report, LIC 809s were provided to administrator.
SUPERVISORS NAME: Fernando Fierros
LICENSING EVALUATOR NAME: Bonnie Tao
LICENSING EVALUATOR SIGNATURE: DATE: 09/21/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/21/2023
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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