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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198603692
Report Date: 11/15/2023
Date Signed: 11/15/2023 11:45:26 AM

Document Has Been Signed on 11/15/2023 11:45 AM - 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:BRADFORD RESIDENTIAL CARE INC.FACILITY NUMBER:
198603692
ADMINISTRATOR:SANTAMARIA, HUMBERTOFACILITY TYPE:
740
ADDRESS:1111 BRADFORD DRIVETELEPHONE:
(626) 233-7489
CITY:GLENDORASTATE: CAZIP CODE:
91740
CAPACITY: 6CENSUS: 0DATE:
11/15/2023
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Humberto & Carmen Satamaria- ApplicantsTIME COMPLETED:
12:00 PM
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Licensing Program Analyst's (LPA's), Valeria Maldonado and Sanjay Vaid conducted an announced visit to the facility for purpose of a pre-licensing evaluation. LPA's met with applicants Humberto and Carmen Santamaria, and explained the purpose of the visit. The facility will be licensed to operate as a Residential Care Facility for the Elderly to serve older adults, ages 60 years and older. The requested capacity is for (6) residents, of which all are non-ambulatory. The facility has an approved dementia care plan and a Hospice Waiver approved for (6).

The facility is a one-story home, located in a residential area. The home consists of (6) resident bedrooms, (1) resident bathroom, (1) visitor/staff bathroom, a kitchen, living room, dining room, office/visitor area, attached garage, and sufficient space indoor and outdoor space for activities. The home has a large kitchen with the necessary utensils and dishware for residents. Sharps were observed stored in a kitchen drawer, locked and inaccessible to residents in care. The food supplies was observed to be the required 2-day perishables and 7-day non-perishables. There is a laundry area where cleaning supplies and first aid kit will be stored separately and locked. The first aid kit had the required items and current first aid manual. All resident bedrooms were observed to have the required furniture, sufficient lighting, and adequate storage space. Bathrooms were inspected and equipped with a toilet, shower, and wash basing. The bathrooms have the required grab bars and non-skid mats. The hot water was tested and measured between 110*F-111*F, which is in compliance. There is a fire place in the office/visitor with a metal screen cover, and is inaccessible to residents. All passageways/walkways are free from obstructions and hazards. Adequate supply of linen, towels, and hygiene supplies were stored in the hallway cabinet. The facility has a working landline telephone system and laptop, available for resident use. All required signage is posted & readily available for review in common areas and at the entrance of the facility. Fire Extinguishers were observed in the kitchen and in the garage, fully charged and with current inspections. Smoke/carbon monoxide detectors were observed, tested, and properly operating. No bodies of water were observed on the premises.
(Report continued on LIC809-C...)
SUPERVISORS NAME: Fernando Fierros
LICENSING EVALUATOR NAME: Valeria Maldonado
LICENSING EVALUATOR SIGNATURE: DATE: 11/15/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/15/2023
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
CCLD Regional Office, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754
FACILITY NAME: BRADFORD RESIDENTIAL CARE INC.
FACILITY NUMBER: 198603692
VISIT DATE: 11/15/2023
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All entrances/exits and windows were equipped with auditory devices and were operational during the visit.

Applicants Humberto & Carmen Santamaria have waived the Component III orientation, as they are currently licensed for another facility of the same category and have completed the orientation.

During the Pre-Licensing inspection, LPA's did not observe items which do not comply with applicable laws and regulations. LPA's have cleared the physical plant.

An exit interview was conducted and a copy of this report has been furnished to the applicants.

Accordingly, LPA's will submit a copy of this facility evaluation report to the Central Applications Bureau (CAB) for review. If the applicant has questions regarding the status of the application, they have been instructed to communicate with the CAB Analyst assigned to their application.
SUPERVISORS NAME: Fernando Fierros
LICENSING EVALUATOR NAME: Valeria Maldonado
LICENSING EVALUATOR SIGNATURE:

DATE: 11/14/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/15/2023
LIC809 (FAS) - (06/04)
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