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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 191593367
Report Date: 10/03/2023
Date Signed: 10/03/2023 03:47:51 PM

Document Has Been Signed on 10/03/2023 03:47 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:HUMAN SERVICES ASSOCIATIONFACILITY NUMBER:
191593367
ADMINISTRATOR:DARREN DUNAWAYFACILITY TYPE:
775
ADDRESS:6800 FLORENCE AVE.TELEPHONE:
(562) 806-5400
CITY:BELL GARDENSSTATE: CAZIP CODE:
90201
CAPACITY: 40CENSUS: 23DATE:
10/03/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Terry Terriquez ADCRC CoordinatorTIME COMPLETED:
04:00 PM
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Licensing Program Analyst (LPA) Glenn Trueman made an unannounced visit and was greeted by Terry Terriquez ADCRC Coordinator and explained the reason for the visit.
The purpose of the visit is to complete the required inspection.
LPA Trueman toured the facility along with Terry Terriquez ADCRC Coordinator today 10/03/2023 at 1:15 PM and the following was observed: : Staff offices, Alzheimer's Day Care Resource Center (ADCRC) room with tables and chairs, kitchen Area, client's restrooms, quiet room and outdoor patio.
Required Annual inspection included Infection Control, Physical Plant and Environmental Safety, Operational Requirements, Staffing, Personnel Records- Training, Client Records- Incident Reports, Client Rights- Information, Food Service, Health Related Services, Incidental medical Services, and Disaster Preparedness.
Program does not store food and doesn't administer medications. Meals are provided daily that are brought in from Human Services Association located in the next building.
All staff were cleared and associated.
Residents are encouraged to maintain and develop their fullest potential for independent living through participation in planned activities.
Visitation signage was posted along with signage for hand washing and proper sanitizing.
Licensee maintained an individual admission agreement for each client.
Fire Clearance has been maintained.
Carbon monoxide detector was observed in the facility.
Each client has personal rights free from corporal or unusual punishment, infliction of pain, humiliation, ridicule, coercion, threats, mental abuse, or other actions of a punitive nature.
Facility was clean, safe, sanitary, and in good repair at all times for the safety and well being of residents, employees and visitors.
5 Resident Files and 5 Staff Files were reviewed.
Interviews were conducted with 3 Staff and 3 Residents.
No deficiencies. Exit interview conducted.
SUPERVISORS NAME: Wei Siew Ho
LICENSING EVALUATOR NAME: Glenn Trueman
LICENSING EVALUATOR SIGNATURE: DATE: 10/03/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/03/2023
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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