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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198603657
Report Date: 06/13/2023
Date Signed: 06/13/2023 03:44:43 PM

Document Has Been Signed on 06/13/2023 03:44 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
GREATER LA AC/SC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754
FACILITY NAME:HOME 'R USFACILITY NUMBER:
198603657
ADMINISTRATOR:ISIDRO, MARGARITAFACILITY TYPE:
740
ADDRESS:10423 TRABUCO ST.TELEPHONE:
(562) 376-0298
CITY:BELLFLOWERSTATE: CAZIP CODE:
90706
CAPACITY: 6CENSUS: 0DATE:
06/13/2023
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Margarita Isidro - Applicant/AdministratorTIME COMPLETED:
04:00 PM
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Licensing Program Analyst (LPA) Bennette Pena conducted an announced Pre-Licensing facility Evaluation visit. LPA met with Applicant Margarita Isidro, Applicant/Administrator who assisted LPA with the visit. The facility is in a residential neighborhood in the city of Bellflower. This single-story home contains four (4) bedrooms, two (2) and 1/2 bathrooms, an office area, a living room, family room, kitchen, dining room, backyard, attached garage and a detached building unit in the back of the property. LPA utilized the Compliance and Regulatory Enforcement (CARE) tools for the visit today and the following was inspected during the evaluation with Margarita Isidro. The physical plant was toured inside and out and the following are observed:

Physical Plant & Environment Safety:

  • It consists of (4) bedrooms, of which (2) bedrooms (bedrooms #1 & 2) are currently occupied by the Applicant and a family member. Fire clearance granted Bedroom #1 for (2) non ambulatory residents only and bedroom #2 for ambulatory only.
  • Bedrooms are large enough to allow for easy passage between and comfortable for usage of beds and other required items of furniture. LPA did not observe mattress pads in the beds in bedrooms 3 & 4.
  • There are two (2) 1/2 bathrooms in the home. LPA observed that the en-suite bathroom (bathroom #1) in Bedroom #1 did not have grab bars and non skid mats in the shower room.
  • LPA observed cleaning solutions stored in an unlocked cabinet under the sink in the 1/2 bathroom.
  • Sufficient supply of linens available to permit weekly changing are available.
  • Sufficient personal hygiene supply available.
  • LPA did not observe a door bell in the front door. Administrator/applicant stated that the door bell was just purchased and will be installed in a few days.
  • The laundry machines are located in the attached garage but has a very tight space. The garage contains (3) mid-size cars and large rolling tool boxes and cabinets.
  • Smoke Detectors were observed throughout the home and were tested and operable. However, the Applicant did not have carbon monoxide in the home.
  • One (1) fire extinguisher is observed in the kitchen area which was purchased on 8/21/2022.
  • Cleaning solutions and sharps were locked and stored separately from where food supplies are stored. .
  • Kitchen cabinets, refrigerator/freezer, oven, microwave, dishwasher are in working condition, clean and sanitary.

***CONTINUED ON LIC 809-C*****
SUPERVISORS NAME: David Sicairos
LICENSING EVALUATOR NAME: Bennette Pena
LICENSING EVALUATOR SIGNATURE: DATE: 06/13/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/13/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 3 of 7
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
GREATER LA AC/SC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754
FACILITY NAME: HOME 'R US
FACILITY NUMBER: 198603657
VISIT DATE: 06/13/2023
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  • The home does not have auditory device that will alert staff to monitor exits.
  • There is insufficient PPE supplies.
  • Applicant/Licensee did not have a safe container to dispose syringes and needles in accordance with the Title 22 Regulations 87303 (g)(1).
  • Doors, exits, hallways, and passageways were clear and free of obstruction.
  • The front yard was observed to have (2) vehicles, one was parked on a car lift and the other one was parked on the ground with a tire lift.
  • LPA observed unused bulk items in the side yard.
  • No pools or bodies of water were observed in or around the property.
  • There are no firearms present at the property.
  • The home does not have a video camera monitor system inside and outside the property.
  • There is a covered outdoor patio area that is furnished for outdoor use.
  • LPA observed a large breed dog with brindle coloration pacing around the backyard.
  • LPA observed a detached building in the backyard and contains (2) bedrooms, kitchen and (1) full bathroom. The building unit has personal items and appears to be occupied and being lived in by individual(s).
  • Equipment and supplies for indoor activities was observed and available for use.
  • Hot water temperature readings did not meet the Title 22 Regulations requirement. Between 10:45am-11:02am, hot water readings were as follows: kitchen measured at 121.2 deg F, 1/2 bath at 121.8 deg F, bathroom #1 at 121.8 deg F and 120.7 deg F in bathroom #2.

Operational Requirements:
  • The Infection Control Plan has been submitted to CCL and the CAB Analyst.
  • The facility has a fire clearance granted by the City of Whittier Fire Department.
  • Fire clearance granted for (4) ambulatory, (2) non ambulatory and (0) bedridden. Bedroom #1 for (2) non ambulatory only and bedrooms 2,3,4 for ambulatory only. However, (2) bedrooms are currently occupied, bedroom #1 is being used by the Applicant and bedroom #2 by a family member.
  • The applicant does not have Liability Insurance in place.
  • Applicant stated that she will not handle resident's cash resources.
  • One (1) operating telephone was observed and tested by LPA on the premises. Telephone is easily accessible and available for residents' use.

***CONTINUED ON LIC 809-C*****
SUPERVISORS NAME: David Sicairos
LICENSING EVALUATOR NAME: Bennette Pena
LICENSING EVALUATOR SIGNATURE:

DATE: 06/13/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/13/2023
LIC809 (FAS) - (06/04)
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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
GREATER LA AC/SC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754
FACILITY NAME: HOME 'R US
FACILITY NUMBER: 198603657
VISIT DATE: 06/13/2023
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Resident Rights-Information:
  • The home has adequate furnishings and equipment to meet the residents' needs.
  • LPA did not observe the Theft and Loss policy posted in the home.
  • LPA did not observe Visitation policy posted.
  • LPA did not observe Labor information posted in the home.

Food Service:
  • Meals will be stored and prepared in a safe manner, necessary to meet the needs of residents.
  • Toxic substances are stored in a locked kitchen cabinet.
  • Food storage and preparation areas, which include pantries, cupboards, drawers and counters were observed to be clean and appropriate for food preparation. Appliances such as a microwave, refrigerator and stove were observed to be clean and operating properly.
  • The refrigerator was observed to be at 45 degrees Fahrenheit and the freezer at 0 degrees Fahrenheit.

Incidental Medical & Dental:
  • First Aid supply was observed and is kept in a small medicine cabinet in the 1/2 bathroom, which included all required supplies.
  • Licensee will use a small medicine cabinet in bathroom #1 but will not accommodate the medications for (6) residents.
  • Applicant did not have a safe container to dispose syringes and needles in accordance with the Title 22 Regulations 87303 (g)(1).
  • List of emergency contacts such as Police, Fire Dept. or paramedic unit was completed by the Applicant/Administrator but not posted in a visible location.
  • The home has one medical resource available to be called at all times.

Disaster Preparedness:

  • The home has a complete Emergency and Disaster Preparedness Plan that includes, EVAC Procedures, Transportation arrangements, Location of all utility shut-off valves and instructions for use
  • There is a contact information list of local emergency response personnel, clients authorized representative or local emergency contact name but not posted and visible to staff and residents.

Component III was also completed at the time of the visit and all required documents for Licensing were discussed. Facility did not meet the physical plant requirements/ inspection as required per California Code of Regulations Title 22 Division 6.


The following corrections need to be made prior to clearing the physical plant:
  • Hot water temperature needs to be adjusted and must meet the Title 22 Regulations requirements of hot water reading to be between 105-120 deg F.
  • Install grab bars and non skid mats in the shower room in Bathroom #1.
  • Need a safe container to dispose syringes and needles in accordance with the Title 22 Regulations 87303 (g)(1)
  • The laundry machines are located in the attached garage has a very tight space. Submit a plan to make the laundry area accessible and safe for residents.
  • Get mattress pads for the beds in bedrooms 3 & 4.
  • Install carbon monoxide.
  • Install auditory devices in exit points and the door bell in the front door.
  • Stock up on additional PPE supplies.
  • Clear the side yard of the unused bulk items.
  • Clear the front yard of parked vehicles to provide clear access.
  • Lock the cleaning solutions stored in the cabinet under the sink in the 1/2 bathroom.
  • Designate an area/place to store the medications for residents. It must be locked, secured and inaccessible to residents.
  • Applicant must purchase liability insurance.
  • The following needs to be posted in a visible location in the home:

    • 1. Theft and Loss policy


    2. Visitation policy
    3. Contact information/list of emergency agencies/Emergency exiting plans
    4. Labor information

LPA will notify the assigned Centralized Applications Bureau (CAB) Analyst of the pre-licensing facility evaluation visit report, as well as the items needing corrections.

Exit interview conducted and a copy of this report was provided to the Applicant/Administrator, Margarita Isidro.

SUPERVISORS NAME: David Sicairos
LICENSING EVALUATOR NAME: Bennette Pena
LICENSING EVALUATOR SIGNATURE:

DATE: 06/13/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/13/2023
LIC809 (FAS) - (06/04)
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