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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 191601550
Report Date: 08/11/2022
Date Signed: 08/11/2022 02:36:15 PM

Document Has Been Signed on 08/11/2022 02:36 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
EL SEGUNDO, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754
FACILITY NAME:NALAS RESIDENTIAL FACILITYFACILITY NUMBER:
191601550
ADMINISTRATOR:FLORA CROWFACILITY TYPE:
735
ADDRESS:19103 ENSLOW DRIVETELEPHONE:
(310) 538-0228
CITY:CARSONSTATE: CAZIP CODE:
90746
CAPACITY: 6CENSUS: 3DATE:
08/11/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:45 AM
MET WITH:Gabriela QuinteroTIME COMPLETED:
02:45 PM
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On 8/11/2022, Licensing Program Analyst (LPA) Perry Scott and Ernand Dabuet conducted an unannounced site visit for the annual inspection, with an emphasis on infection control. During today’s visit, LPAs met with assistant administrator Gabriela Quintero and explained the reason for the visit. The facility is licensed to serve six (6) adults ages 18 through 59 years old. There are currently three (3) clients residing in the facility.

The facility is located in a residential area. A tour of the single-story facility includes: Kitchen, dining room, living room, 4 client bedrooms, 1 staff bedroom, 2 bathrooms, recreation room and laundry area. During today's visit, LPA observed the following: All outdoor and indoor passageways are kept free of obstruction. There are no pools and bodies of water on the premises. There are no firearms and other dangerous weapons on the premises. A comfortable temperature for clients is maintained. Lamps or lights are in all rooms. Hot water temperature measured at 118.9 degrees Fahrenheit. All toilets, washing and bathing facilities are safe, sanitary and in operating condition. Hygiene products such as soap, toilet paper, toothbrush, toothpaste, and comb were observed. Non-perishable foods for a minimum of one week and fresh perishable foods for a minimum of two days are available. Freezers and refrigerators are kept clean and in working condition.

All bedrooms were checked. Mattresses were in good condition, adequate lighting, plenty of dresser and closet space observed. Walls and floors were clean and in good condition. Comforters, bed linen, bath towels and mattress protectors were adequately stocked. Bathroom toilets and water faucets worked properly. Sufficient toiletries accessible to clients. Fire extinguishers were last serviced on 03/10/22 and a fire drill was conducted on 08/09/22. While checking employee files it was noted that one of the employees did not have their booster shots which are required per pin # 22-20-ASC.
SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Perry Scott
LICENSING EVALUATOR SIGNATURE: DATE: 08/11/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/11/2022
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 2
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754
FACILITY NAME: NALAS RESIDENTIAL FACILITY
FACILITY NUMBER: 191601550
VISIT DATE: 08/11/2022
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During the visit, LPAs observed the following to be in compliance: the facility's infection control practices; screening protocols for visitors, staff, and residents, sanitizing stations in common areas and restrooms; every staff was wearing a face covering; the facility has a 30-day supply of Personal Protective Equipment (PPE). All mandated inspection control posters were posted. The facility has a Mitigation Plan Report approved by CCLD.

Advisory note-Technical assistance was issued, please see LIC9102-AN

No deficiencies cited. Exit Interview Conducted and a copy of report was given to assistant administrator Gabriela Quintero.

SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Perry Scott
LICENSING EVALUATOR SIGNATURE:

DATE: 08/11/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/11/2022
LIC809 (FAS) - (06/04)
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