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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 191603749
Report Date: 12/16/2022
Date Signed: 12/16/2022 11:12:36 AM

Document Has Been Signed on 12/16/2022 11:12 AM - 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:MANOR, THEFACILITY NUMBER:
191603749
ADMINISTRATOR:STEPHANIE BROWNFACILITY TYPE:
735
ADDRESS:1905/2019 PICO BOULEVARDTELEPHONE:
(310) 450-1748
CITY:SANTA MONICASTATE: CAZIP CODE:
90405
CAPACITY: 151CENSUS: 142DATE:
12/16/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:15 AM
MET WITH:Stephanie BrownTIME COMPLETED:
12:00 PM
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On 12/16/22 at 9:15am, Licensing Program Analyst (LPA) Perry Scott conducted an unannounced annual required visit with a primary focus on Infection Control measures using the new CARE Inspection Tool. LPA met with administrator, Stephanie Brown, and the purpose of today’s visit was explained. The facility is licensed to serve one hundred fifty-one (151) clients ages 18-59. The facility consists of two buildings with 142 residents. The main building includes the kitchen, dining area, lounge, and outside covered patio area. The facilities annual dues are current.

As part of the inspection, my primary focus was on infection control. LPA observed the facility’s infection control practices: LPA observed a sanitizing station at the facility entrance. PPE supplies are readily available to staff and residents, and additional supplies are stored. Sufficient paper, cleaning, and disinfecting supplies were observed. The facility has the mandated COVID infection control posters.

LPA Scott and Ms. Brown toured both buildings. Twenty (20) units consisting of several bedrooms and a shared bathroom were inspected. Building one (1) located at 1905, LPA inspected unit 22 room A/B/C, unit 8 room A/B, and unit 25 room A. Each room consisted of a bed, bedding supplies, adequate lighting, nightstand, dresser, and chair. LPA observed a storage area for the residents’ personal belongings. Building two (2) located at address 2019, LPA inspected unit 1,3, and 13 for rooms A/B in each unit. LPA observed that all rooms were adequately furnished within title 22 guidelines. LPA observed that the garden/plant area was well maintained, as well as the laundry area in both buildings on this visit.

Report continues on LIC809-C
SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Perry Scott
LICENSING EVALUATOR SIGNATURE: DATE: 12/16/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/16/2022
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
EL SEGUNDO, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754
FACILITY NAME: MANOR, THE
FACILITY NUMBER: 191603749
VISIT DATE: 12/16/2022
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LPA further observed that personal hygiene supplies were available, and storage areas for cleaning agents, toxins, and sharps were inaccessible to clients. The bathrooms are clean and operational. There was a swimming pool on the main building grounds in 1905, with a 5-foot fence surrounding the pool meeting title 22 regulations. Smoke/carbon monoxide detectors are operable. No firearms are stored at facility.

The kitchen was inspected and there is sufficient perishable and non-perishable food available and maintained properly. There are several other freezers that store frozen food for the residents. Medications are centrally stored, locked, and inaccessible to clients. The water temperature measured at 111.6 F degrees. Fire extinguishers are fully charged. LPA observed several First Aid kits complete with manuals. Exit, walkways and/or passageways were free of debris and/or hazards.

During the visit, LPA observed the facility infection control practices. LPA observed screening protocols for visitors, staff and residents, sanitizing stations (Located in common areas and restrooms). LPA observed that the staff were wearing the mandated face coverings and the facility had the required postings posted throughout each building.

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.

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.

An exit interview was conducted with Stephanie Brown, administrator, and copy of the Facility Evaluation Report was provided.

End of report.

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

DATE: 12/16/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/16/2022
LIC809 (FAS) - (06/04)
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