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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198603675
Report Date: 06/27/2023
Date Signed: 06/27/2023 12:31:53 PM

Document Has Been Signed on 06/27/2023 12:31 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:BRADFORD RESIDENCEFACILITY NUMBER:
198603675
ADMINISTRATOR:LOPEZ, LORRAINE FRANCESFACILITY TYPE:
740
ADDRESS:1238 W. CIENEGA AVETELEPHONE:
(626) 890-7634
CITY:SAN DIMASSTATE: CAZIP CODE:
91773
CAPACITY: 6CENSUS: 0DATE:
06/27/2023
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
09:38 AM
MET WITH:Lorraine Lopez Licensee, Megan Hill, AdministratorTIME COMPLETED:
12:44 PM
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Licensing Program Analyst (LPA) Alberto Lopez made an announced visit and was greeted by Administrator Megan Hill and Licensee Lorraine Lopez for the purpose of conducting a pre-licensing and Component 3 visit.

Tour was conducted and the following was observed; medications were in a locked area, physical plant is in good repair, smoke detectors operate properly, fire extinguishers are properly charged, cleaning solutions and sharps are locked, building and grounds are free from hazards, handrails are securely fastened, passageways, and doors are not blocked or obstructed, signal system is operable, beds have the required linen/supplies, mattresses and bedsprings are in good repair, clients have the appropriate furniture (one chair, night stand, adequate lighting for each client, adequate closet and drawer space), bedrooms are large enough to allow for easy passage between and comfortable for usage of beds and other required items of furniture and any assistant devices such as walkers, water temperature was within normal range (105 F to 120 F) degrees Fahrenheit. Refrigerator, stove, telephone, sinks, tubs, toilets and showers operate properly. There are enough bath towels, hand towels and wash cloths for all clients. Sufficient amount of personal hygiene supplies is available for clients.

There are enough linens available to permit weekly changing to ensure use of clean linens at all times by residents. All bathrooms were equipped with grab bars and non-skid mats with the exception of one restroom toilet that Licensee will install soon. Pantry's cupboards, freezers, stoves, microwaves, refrigerator and counters are clean. Garbage cans have tight fitting covers. Two-day supply of perishables available, seven-day supply of non-perishable available. Menu available for review. The facility has sufficient dining tables and chairs. Pesticides and other toxic substances are stored and locked away from food supply. Resident records are inaccessible to unauthorized persons. Emergency disaster plan, personal rights and complaint procedures are posted.

continued on (809C)

SUPERVISORS NAME: Lisa Hicks
LICENSING EVALUATOR NAME: Alberto Lopez
LICENSING EVALUATOR SIGNATURE: DATE: 06/27/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/27/2023
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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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: BRADFORD RESIDENCE
FACILITY NUMBER: 198603675
VISIT DATE: 06/27/2023
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First Aid Kit is fully stocked. There is adequate seating in common area for licensed capacity. No client’s bedrooms are used as public or general passageway to another room, bath or toilet. Night lights are maintained in the hallway and passages to non-private bathrooms. Post labor information as required by law is posted. Notices of planned activities are posted in a central facility location readily accessible to clients, relatives and representatives of placement and referral agencies. Activity supplies, available. Privacy is provided in all toilet, bath and shower areas. Facility has a theft and loss policy posted. Emergency exiting plans and telephone numbers are posted. Procedures to file confidential complaints are posted; a copy of resident rights or instructions on how to obtain a copy of the rights is provided to residents. There is a working telephone. Carbon monoxide detector is operable.


The following rooms were inspected: #01, 02, 03, 04.
Physical plant will meet Title 22 Regulations when grab bar is installed in restroom #2

Exit interview conducted and copies provided.
SUPERVISORS NAME: Lisa Hicks
LICENSING EVALUATOR NAME: Alberto Lopez
LICENSING EVALUATOR SIGNATURE:

DATE: 06/27/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/27/2023
LIC809 (FAS) - (06/04)
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