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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 191592599
Report Date: 03/16/2023
Date Signed: 03/16/2023 03:09:34 PM

Document Has Been Signed on 03/16/2023 03:09 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, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754
FACILITY NAME:FOUNDERS HOUSE OF HOPEFACILITY NUMBER:
191592599
ADMINISTRATOR:CRYSEL SANTOSFACILITY TYPE:
735
ADDRESS:18025 PIONEER AVE.TELEPHONE:
(562) 860-3351
CITY:ARTESIASTATE: CAZIP CODE:
90701
CAPACITY: 98CENSUS: 81DATE:
03/16/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:05 AM
MET WITH:Administrator- Crysel SantosTIME COMPLETED:
03:15 PM
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Licensing Program Analyst (LPA) Ashley Calderon and LPA Valeria Maldonado made and unannounced visit to conduct the Annual inspection focused on domains within the Compliance and Regulatory Enforcement (Care) Tools. Upon visit LPA met with Administrator Crysel Santos.

LPA Calderon along side Crysel Santos used Care Tools and conducted a tour of the facility. Tour consisted of common rooms but not limited to activity room, dining room, and billiard room. LPA toured kitchen and client rooms (Rm). Facility serves mentally disabled adults ages 18-59 years old, ambulatory only. LPA Calderon interviewed (4) clients and (3) staff.

The following was conducted and inspected:
  • Outdoor and indoor passageways are free of obstruction.
  • Bathrooms were operable and hot water in clients rooms were measured between Title 22 regulations.
  • Smoke detectors were tested. The last fire drill was conducted on 2/24/2023. Done monthly.
  • Hallway fire alarms are pull system, smoke detectors/carbon monoxide are interconnected and connected with Cerritos Fire Department.
  • Required postings observed.
  • Fire extinguishers are located in 14 areas fully charged and serviced.
  • Sufficient supply of extra linen, towels and personal hygiene supplies stored inside the hallway cabinet.
  • Facility temperature for clients was maintained at comfortable temperature, client's have wall heaters, fans/ AC units.
  • Washer/Dryer appliances observed in Laundry Room.
  • Patios are in good condition, shaded area is provided.
  • PPE was observed and staff have completed FIT Testing
(Continuation on 809-C...)
SUPERVISORS NAME: Fernando Fierros
LICENSING EVALUATOR NAME: Ashley Calderon
LICENSING EVALUATOR SIGNATURE: DATE: 03/16/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/16/2023
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: FOUNDERS HOUSE OF HOPE
FACILITY NUMBER: 191592599
VISIT DATE: 03/16/2023
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KITCHEN:
  • Freezers/refrigerators appear sanitary and temperature maintained. There is an extra refrigerator and freezer.
  • Sufficient non-perishable and perishable food items for clients in care, emergency canned goods stored in hallway and in pantry room.
  • Sharps are inaccessible to clients.

BEDROOMS:
  • LPA Calderon toured rm numbers: 5,8, 24, 26, 27, 36, 38, 41, 43, and 47, rm's had required furnishing and in good condition.
  • Beds have the required linen/supplies which include, pillowcase, mattress padding, fitted sheet, blanket and bedspreads.

MEDICATION:
  • Medications are stored, locked and inaccessible to clients, located in medication room.
  • Medication and First Aid Kit reviewed.
  • LPA Maldonado reviewed (5) client medications and Medication Log. Medications given as prescribed and documented properly.

RECORD REVIEW:
LPA Maldonado reviewed Staff and Client files. As a part of the inspection reviewed (5) client records, (5) staff files.
  • Facility Administrator Certificate for Crysel Santos expires on 06/20/24.
  • Client file reviewed, no deficiencies.
  • Staff files reviewed, all finger printed and trained, no deficiencies observed.

Care Tool was completed and based on Title 22 Regulations, no deficiencies cited per California Code of Regulations, Title 22, Division 6.

An exit interview was conducted with Administrator Crysel Santos and a copy of today's reports were provided.
SUPERVISORS NAME: Fernando Fierros
LICENSING EVALUATOR NAME: Ashley Calderon
LICENSING EVALUATOR SIGNATURE:

DATE: 03/16/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/16/2023
LIC809 (FAS) - (06/04)
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