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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 191601550
Report Date: 07/27/2023
Date Signed: 07/27/2023 01:40:56 PM

Document Has Been Signed on 07/27/2023 01:40 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: 4DATE:
07/27/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:52 AM
MET WITH:Miguel SanchoTIME COMPLETED:
02:00 PM
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On 07/27/2023, Licensing Program Analyst (LPA) Perry Scott conducted an unannounced annual required visit using the new Cares Tool. During today’s visit, LPA was met by Miguel Sancho, DSP and the purpose of today’s visit was explained. The facility is licensed to serve six (6) Developmentally disabled adults ages 18 through 59 years old; of which (4) may be ambulatory and (2) non-ambulatory. There are currently (4) clients residing in the facility. The clients are Harbor Regional Center clients. None of the clients have Restricted Health Care Conditions and none are utilizing postural supports or protective devices. The facilities annual fees are current.

The facility is a single-story structure located in a residential neighborhood. A tour of the facility includes kitchen, dining room, living room, (4) client bedrooms, (1) staff bedroom, (2) bathrooms, recreation room and laundry area.

LPA conducted a records review of (4) client records, (3) staff records, (4) clients Personal & Incidental Records and reviewed the facility disaster plan. All client & Staff records were complete. The facility disaster plan was current and in compliance with Title 22 at the time of visit. LPA reviewed (4) Client Medication Administration Records and did not observe any discrepancies at the time of visit.

During today's visit, LPA observed the following: all outdoor and indoor passageways are kept free of obstruction. There are no pools, bodies of water, or firearms on the premises. A comfortable temperature for the residents is maintained. Hot water temperature measured at 109.1 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. All bedrooms were checked. Mattresses were in good condition, adequate lighting, plenty of dresser and closet space observed.

LPA observed that bed linens and towels were adequately stocked. Walls and floors were clean and in good condition. The kitchen was inspected and there is enough perishable and non-perishable food available which is stored properly. Fire extinguishers were charged, smoke and carbon monoxide detectors were operable. The last fire/emergency drill was conducted on 07/10/2023.

Report continued on LIC809-C

SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Perry Scott
LICENSING EVALUATOR SIGNATURE: DATE: 07/27/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/27/2023
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: 07/27/2023
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During the visit, LPA observed the facility infection control practices. LPA observed screening protocols for visitors, staff, and residents. LPA observed that sanitizing stations were in common areas and restrooms. LPA observed that the facility had the required postings, posted throughout the facility. LPA further observed the facility to have a 60-day supply of Personal Protective Equipment (PPE).

LPA advised the administrator to continuously monitor the Centers for Disease Control (CDC) website and Community Care Licensing (www.cdss.ca.gov) for Provider Informational Notices (PIN) and for any updates relating to COVID-19 guidance and other related issues.

According to the California Code of Regulations (Title 22, Division 6, Chapter 8), LPA did not observe any deficiencies, therefore no citations were issued at this time.

Exit interview held and a copy of the report was provided to Miguel Sancho, DSP.

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

DATE: 07/27/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/27/2023
LIC809 (FAS) - (06/04)
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