<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198603655
Report Date: 06/20/2024
Date Signed: 06/20/2024 05:08:53 PM

Document Has Been Signed on 06/20/2024 05:08 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:ALTA VISTA CARE HOMEFACILITY NUMBER:
198603655
ADMINISTRATOR/
DIRECTOR:
ENRIQUEZ,ALMA/STINSON,NICOFACILITY TYPE:
740
ADDRESS:5349 N. OAKBANK AVE.TELEPHONE:
(626) 587-0088
CITY:COVINASTATE: CAZIP CODE:
91722
CAPACITY: 6CENSUS: 6DATE:
06/20/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:00 PM
MET WITH:Alma Enriquez, administratorTIME VISIT/
INSPECTION COMPLETED:
05:00 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
Licensing Program Analyst (LPA) Tao conducted an unannounced annual inspection visit. LPA met with Administrator, Alma Enriquez, who assisted with the visit. Facility is licensed to serve six (6) non-ambulatory elderly residents, ages 60 and above. No bedridden allowed. Hospice waiver approved for six (6) residents. Facility had dementia special care program.

During the visit, CARE tool was used, a tour of the facility was conducted, food supply/medication were reviewed, staff/residents were interviewed and staff/residents records were reviewed.

The facility was a single-family residence located in a neighborhood, consisted of six (6) bedrooms, four (4) bathrooms, kitchen, dining room, living room with TV, laundry room, storage room, and administrative area. Passageways, walkways and patios are free from obstructions. All the rooms were furnished with appropriate furniture for residents’ comfort. The bathrooms were furnished with grab bars and nonskid surfaces. Common areas were observed for the ability to safely serve the needs of the residents. Hot water temperature was 119.5 degrees Fahrenheit. No pools and bodies of water on the premises. Facility maintained a comfortable temperature for residents. Auditory alarm devices to monitor exits were operable. Interior and exterior space available to permit residents to wander freely and safely. Sufficient supplies of perishable and nonperishable foods were observed. Toxic substances, knives, tools, sharp items were inaccessible to residents. Smoke detectors and carbon monoxide detectors were operable. Fire extinguishers' last service was 7/19/23 and were fully charged. Medication, residents’/ staff’s records were centrally stored in a locked cabinet and inaccessible to residents.

No deficiencies were observed and cited per California Code of Regulations, Title 22. An exit interview was conducted. This report was discussed and provided to Administrator, Alma.
SUPERVISORS NAME: Fernando Fierros
LICENSING EVALUATOR NAME: Bonnie Tao
LICENSING EVALUATOR SIGNATURE: DATE: 06/20/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/20/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 1