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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198603590
Report Date: 10/15/2024
Date Signed: 10/15/2024 04:59:02 PM

Document Has Been Signed on 10/15/2024 04:59 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/
DIRECTOR:		TRUONG, PHUOCFACILITY TYPE:
740
ADDRESS:16136 E CLOVERMEAD ST.TELEPHONE:
(626) 456-1066
CITY:COVINASTATE: CAZIP CODE:
91722
CAPACITY: 6CENSUS: 5DATE:
10/15/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:00 PM
MET WITH:Phuoc (Henry) Truong, administratorTIME VISIT/
INSPECTION COMPLETED:
05:00 PM
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Licensing Program Analyst (LPA) Tao conducted an unannounced annual inspection visit. LPA met Phuoc (Henry) Truong, administrator. LPA explained the purpose of the visit. The facility has a capacity of six (6) including five (5) non-ambulatory and one (1) bedridden. The facility has approved of six (6) hospice waiver. Currently, five (5) residents are non-ambulatory and no bedridden residing at the facility. Annual licensing fees are current. Two live-in staff are residing in bedroom #6.

The inspection consisted of using CARE tool, conducting physical plant, review of food supply, reviews of staff/residents records and medications.

The facility is a single-story house located in a residential neighborhood in Covina consisted of six (6) resident bedrooms, two (2) bathrooms, living room, kitchen, backyard with shaded area, and laundry room. Residents' bedrooms have dresser, chairs and closet spaces available. Bathrooms, kitchen, common areas were inspected and in compliance. Dual combo of smoke and carbon monoxide detectors are operable. Fire extinguishers are fully charged. Auditory devices are operable. Medication is centrally stored. Resident records are stored in a locked storage room and inaccessible to residents. Two (2) days perishable and seven (7) days non-perishable were observed. Hot water temperature was in a range of 114.2 degrees Fahrenheit which was within Title 22 Regulation guidelines. Annual fees are current.

No deficiency is cited per California Code of Regulations, Title 22. An exit interview was conducted and this report was provided to Henry, administrator.
SUPERVISORS NAME: Fernando Fierros
LICENSING EVALUATOR NAME: Bonnie Tao
LICENSING EVALUATOR SIGNATURE: DATE: 10/15/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/15/2024
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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