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

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306005897
Report Date: 02/24/2022
Date Signed: 02/24/2022 02:45:27 PM

Document Has Been Signed on 02/24/2022 02:45 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, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME:PARLIAMENT GUEST HOME, THEFACILITY NUMBER:
306005897
ADMINISTRATOR:VALENCIA, VICTORIAFACILITY TYPE:
740
ADDRESS:10591 PARLIAMENT AVETELEPHONE:
(714) 496-8302
CITY:GARDEN GROVESTATE: CAZIP CODE:
92840
CAPACITY: 6CENSUS: 4DATE:
02/24/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:45 PM
MET WITH:Administrator, Victoria ValenciaTIME COMPLETED:
03:00 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
On this day Licensing Program Analyst's (LPA's) Jenifer Tirre and Andrea Mendivil conducted an unannounced visit for the purpose of conducting a required/ annual visit. LPA's were greeted and was granted entry into the facility by Caregiver. Upon entry LPA's temperature was checked and logged. LPA's explained the reason for the visit.

During the visit Administrator Victoria Valencia arrived. LPA's toured the facility with Caregiver and Administrator. Facility is a 6 bedroom (4 resident rooms and 2 staff rooms) and 4 bathroom single story home. There are 4 Clients in care. LPA's observed facility has required Department postings. LPA's toured all clients rooms, all rooms where within regulations. All restrooms observed contained working water basin, soap, toilet paper and hand towels. Restrooms had proper hand washing signs posted. Clients were observed relaxing in living room and bedrooms.

Facility has PPE supplies. Administrator was explained the importance of having 30 day supply on hand. Facility has 2 refrigerators and pantry's with ample food supply. LPA's observed facility has emergency food and water supply. Facility has 2 fire extinguishers which are fully charged. Facility has Emergency plan posted. Facility has a secured location for Client medication and files. Facility has 30 days supply of medications for clients. LPA's reviewed Clients files during visit. Clients emergency contact information and physicians reports are current. Facility has designated visitation area.

An exit interview was conducted with Administrator Victoria Valencia and copy of report was left at facility.
SUPERVISORS NAME: Alisa Ortiz
LICENSING EVALUATOR NAME: Jenifer Tirre
LICENSING EVALUATOR SIGNATURE: DATE: 02/24/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/24/2022
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