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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 191640255
Report Date: 02/01/2022
Date Signed: 02/01/2022 05:29:00 PM

Document Has Been Signed on 02/01/2022 05:29 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 DR #100
MONTEREY PARK, CA 91754
FACILITY NAME:FRANK'S ADULT RESIDENTIAL HOMEFACILITY NUMBER:
191640255
ADMINISTRATOR:EDWARD GOODSONFACILITY TYPE:
735
ADDRESS:1911 W. 137TH STREETTELEPHONE:
(310) 632-1213
CITY:COMPTONSTATE: CAZIP CODE:
90222
CAPACITY: 16CENSUS: 13DATE:
02/01/2022
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
04:15 PM
MET WITH:Edward GoodsonTIME COMPLETED:
05:45 PM
NARRATIVE
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Licensing Program Analyst (LPA) Ulysses Coronel and LPA Jeremiah Randle initiated a Case Management - Deficiencies visit to document deficiencies observed during the investigation of a complaint with complaint control number 11-AS-20220131083928. Today’s visit was conducted with Edward Goodson, the facility administrator and the purpose of the visit was explained.

During todays visit LPAs Coronel and Randle observed that 2 of the facility's refrigerators are locked with chains and padlocks,.

During todays visit LPAs observed that expired canned goods, dry goods and fruit juices were being stored along with non perishable food supplies.

California Code of Regulations, Title 22, Division 6 and Chapter 1 are being cited on the attached LIC809D.

An exit interview was conducted and plans of Corrections were developed. A copy of this report and appeals rights were provided.
SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Ulysses Coronel
LICENSING EVALUATOR SIGNATURE: DATE: 02/01/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/01/2022
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
Document Has Been Signed on 02/01/2022 05:29 PM - It Cannot Be Edited


Created By: Ulysses Coronel On 02/01/2022 at 04:22 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754

FACILITY NAME: FRANK'S ADULT RESIDENTIAL HOME
FACILITY NUMBER: 191640255

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/01/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
02/15/2022
Section Cited
CCR
80072(a)(3)

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Personal Rights. Except for children’s residential facilities, each client shall have personal rights which include, but are not limited to, the following:To be free from corporal or unusual punishment, ... mental abuse, or other actions of a punitive nature, including...: interference with.., including eating, ...functioning.
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The administrator agreed to removed locks from refrigerators and create a plan to ensure that foods are accessible to clients in care.
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This requirement was not met as evidenced by: LPAs observed 2 refrigarators containing food locked with chains and padlocks, which poses a potential health and safety risk to clients in care.
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Type B
02/15/2022
Section Cited
CCR80076(a)

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Food Services. In facilities providing meals to clients, the following shall apply: All food shall be safe and of the quality...necessary to meet the needs of the clients. Each ...served. All food shall be selected, stored, prepared and served in a safe and healthful manner. This requirementy was not met as evidenced by:
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The administrator agreed to have all expired food supply disposed of today and create a plan to ensure that expired food is not maintained in the facility.
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Based on LPA observations the licensee failed to ensure that food are safe and are stored in a safe and healthfull manner, expired food supply is being kept along with the facility's non-perishable food supply which poses a potential health and safety risk to clients in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Janae Hammond
LICENSING EVALUATOR NAME:Ulysses Coronel
LICENSING EVALUATOR SIGNATURE:
DATE: 02/01/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/01/2022


LIC809 (FAS) - (06/04)
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