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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374604108
Report Date: 02/08/2024
Date Signed: 02/08/2024 12:25:23 PM

Document Has Been Signed on 02/08/2024 12:25 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, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME:PERPETUAL HELP HOME CAREFACILITY NUMBER:
374604108
ADMINISTRATOR:RAMIREZ, JOSE & HELENFACILITY TYPE:
740
ADDRESS:29531 MACTAN RDTELEPHONE:
(709) 913-5580
CITY:VALLEY CENTERSTATE: CAZIP CODE:
92082
CAPACITY: 6CENSUS: 6DATE:
02/08/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:18 AM
MET WITH:LEAD CAREGIVER, ELVIRA MANGABARTIME COMPLETED:
12:31 PM
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On February 08, 2024, Licensing Program Analyst (LPA), Venus Mixson arrived at the facility unannounced to conduct the required annual inspection and interviewed the Administrator, Jose Ramirez, via the telephone. The facility file review was conducted in the office and additional records were requested and reviewed on site. The facility is licensed for six elderly adults and is operating at full capacity. LPA met with the Lead Caregiver Elvira.

LPA Mixson toured the facility along with Lead Caregiver, Elvira Mangabat and inspected the facility inside and outside. There were no obstructions to the indoor or outdoor passageways currently at the time of this visit. The facility is a single-story home, located at 29531 Mactan RD, Valley Center, CA 92082. Physical Plant: The facility phone number is (858) 610-4098 and is operable. The LPA observed the residents’ bedrooms, and they are equipped with required furniture as per Title 22. The LPA inspected facility bathrooms, and the hot water temperature tested within regulations. The bathrooms were clean, and appliances were operating appropriately currently at the time of this visit. The facility is equipped with operating smoke detectors, carbon monoxide alarms, and fire extinguishers. The LPA observed required postings such as "If you See Something, Say Something" the "Personal Rights" and the Ombudsman postings were posted in a common area. The cleaning supplies and sharp items were kept locked and inaccessible to the residents in care. There was a designated storage space for the resident and staff files, and it was locked. Medications: were reviewed, locked and inaccessible to residents, and there was a 30-day supply. The overall facility is clean, the furniture is in good condition. The facility heating system and other appliances were operable currently at the time of this visit. Food Service: Non-perishable and perishable food supply is sufficient per regulations, and there are a variety of food types available for residents. Dishes and utensils were in sufficient supply and stored properly. Care & Supervision Facility has sufficient staff, one staff at the time of this visit and the staff were engaging the residents with a meal and ADL's. Records Review: The LPA reviewed staff and resident files, conducted staff and resident interviews, and reviewed previous Community Care Licensing forms. There were no Title 22, Division 6 Regulation violations observed or cited during today’s visit. An exit interview was conducted, and a copy of this report was given to the Lead Caregiver, Elvira Manabat.
SUPERVISORS NAME: Jazmond D Harris
LICENSING EVALUATOR NAME: Venus Mixson
LICENSING EVALUATOR SIGNATURE: DATE: 02/08/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/08/2024
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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