191640255-6-13-2025-11-AS-JANO-DHLVW9-20250613164731

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 191640255
Report Date: 06/13/2025
Date Signed: 06/13/2025 04:51:03 PM

Document Has Been Signed on 06/13/2025 04:51 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 ASC, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245

FACILITY NAME:	FRANK'S ADULT RESIDENTIAL HOME		FACILITY NUMBER:	191640255
ADMINISTRATOR/ DIRECTOR:	EDWARD GOODSON		FACILITY TYPE:	735
ADDRESS:	1911 W. 137TH STREET		TELEPHONE:	(310) 632-1213
CITY:	COMPTON	STATE: CA	ZIP CODE:	90222
CAPACITY: 16		CENSUS: 16	DATE:	06/13/2025
TYPE OF VISIT:	Case Management - Annual Continuation	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	08:00 AM
MET WITH:	Edward Goodson		TIME VISIT/ INSPECTION COMPLETED:	04:30 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	On 06/13/2025, Licensing Program Analyst (LPA) Jose Anguiano conducted a case management annual continuation visit from 06/12/2025 using the CARE Inspection Tool. LPA met with Administrator Edward Goodson and explained the purpose of the visit. The facility is licensed to provide care for ambulatory adults, ages 18–59, with a capacity of 16 and a current census of 16 clients in care. The facility is a two-story structure located in a residential neighborhood and consists of 10 bedrooms, 3 bathrooms, a kitchen, 2 dining areas, outdoor laundry area, administrative offices, and an outdoor space with shaded seating. LPA conducted a tour of the physical plant. No bodies of water were observed. Resident rooms were inspected—beds, lighting, and storage were in good condition. Clean linens and towels were available. Bathrooms were operational with hot water measured at 115°F. The facility was observed to be furnished. The kitchen was stocked with at least 2 days of perishable and 7 days of non-perishable food. Fire extinguishers were charged, and smoke and carbon monoxide detectors were operable.

NAME OF LICENSING PROGRAM MANAGER: Stephanie Cifuentes
NAME OF LICENSING PROGRAM ANALYST: Jose Anguiano
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 06/13/2025

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/13/2025

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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California Health & Human Services Agency

California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:

Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.

Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)

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Document Has Been Signed on 06/13/2025 04:51 PM - It Cannot Be Edited

Created By: Jose Anguiano On 06/13/2025 at 12:46 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
, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245

FACILITY NAME: FRANK'S ADULT RESIDENTIAL HOME	FACILITY NUMBER: 191640255
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 06/13/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type A

Section Cited

CCR

80087(a)

Building and Grounds

(a) The facility shall be clean, safe, sanitary and in good repair at all times for the safety and well-being of clients, employees and visitors. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation, the licensee did not ensure bathrooms were clean and sanitary, the upstairs bathroom was in disrepair, and bedrooms had a strong odor of cigarette smoke, posing a potential health and safety risk to residents.
	POC Due Date: 07/01/2025
	Plan of Correction
1 2 3 4	Licensee will clean and sanitize bedrooms and create a cleaning log, upstair bathroom needs to be repaired. Licensee will create a plan to ensure that facility is clean, safe, sanitiry, and in good repair at all times. Licensee will email proof of correction to Jose.Anguiano@dss.ca.gov

Section Cited


	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

	Stephanie Cifuentes
NAME OF LICENSING PROGRAM MANAGER:

	Jose Anguiano
NAME OF LICENSING PROGRAM ANALYST:

LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 06/13/2025

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/13/2025

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 06/13/2025 04:51 PM - It Cannot Be Edited

Created By: Jose Anguiano On 06/13/2025 at 12:46 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
, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245

FACILITY NAME: FRANK'S ADULT RESIDENTIAL HOME	FACILITY NUMBER: 191640255
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 06/13/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

80020(c)

Fire Clearance

(c) A licensee of an Adult Residential Facility or Group Home utilizing secured perimeters shall conduct fire and earthquake drills pursuant to Health and Safety Code section 1531.15(h). This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on record review, the licensee did not comply with the section cited above which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 07/01/2025
	Plan of Correction
1 2 3 4	Licensee will create a plan to ensure compliance with CCR80020(c) and email proof of correction to Jose.Anguiano@dss.ca.gov

Type B

Section Cited

CCR

80075(f)

Health-Related Services

(f) Staff responsible for providing direct care and supervision shall receive training in first aid from persons qualified by agencies including but not limited to the American Red Cross. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on record review, the licensee did not comply with the section cited above which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 07/01/2025
	Plan of Correction
1 2 3 4	Licensee will ensure that all residents providing care in the facility possess a current and valid CPR certificate on file, as required by 22 CCR §80075(f). Licensee will verify documentation and maintain records in each applicable file. Proof of correction will be submitted via email to Jose.Anguiano@dss.ca.gov

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

	Stephanie Cifuentes
NAME OF LICENSING PROGRAM MANAGER:

	Jose Anguiano
NAME OF LICENSING PROGRAM ANALYST:

LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 06/13/2025

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/13/2025

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 06/13/2025 04:51 PM - It Cannot Be Edited

Created By: Jose Anguiano On 06/13/2025 at 12:46 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
, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245

FACILITY NAME: FRANK'S ADULT RESIDENTIAL HOME	FACILITY NUMBER: 191640255
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 06/13/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

80075(b)

Health-Related Services

(b) Clients shall be assisted as needed with self-administration of prescription and nonprescription medications. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on record review, the licensee did not comply with the section cited above in 5 out 5 client records not having their Medication Administration Record filled out which poses/posed a potential health, safety or personal rights risk to persons in care
	POC Due Date: 07/01/2025
	Plan of Correction
1 2 3 4	Licensee will re-train staff on how to document MAR records and create a plan to stay in compliance. Licensee will email proof of correction to Jose.Anguiano@dss.ca.gov

Type B

Section Cited

HSC

1565(a)

Other Provisions

(a) A facility shall have an emergency and disaster plan that shall include, but not be limited to, all of the following: This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on record review, the licensee did not comply with the section cited above in not having an emergency and plan which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 07/01/2025
	Plan of Correction
1 2 3 4	Licensee will create an an emergency and plan and email it to Jose.Anguiano@dss.ca.gov

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

	Stephanie Cifuentes
NAME OF LICENSING PROGRAM MANAGER:

	Jose Anguiano
NAME OF LICENSING PROGRAM ANALYST:

LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 06/13/2025

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/13/2025

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 ASC, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245

FACILITY NAME: FRANK'S ADULT RESIDENTIAL HOME	FACILITY NUMBER: 191640255
	VISIT DATE: 06/13/2025

NARRATIVE

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During the inspection, LPA observed several areas requiring correction. Bathrooms were not maintained clean and sanitary, and one upstairs bathroom was in disrepair. Bedrooms had a noticeable odor of cigarette smoke. Cleaning supplies were observed accessible to residents. LPA reviewed 5 client records and 5 staff records. Several staff and client files were missing required documentation.

A total of six deficiencies were cited under California Code of Regulations, Title 22, Division 6, Chapters 1, 6, and 8 during this visit. Three of the deficiencies were repeat violations previously cited and not corrected by the licensee.

Civil penalties were assessed for failure to correct repeat violations, in accordance with Health and Safety Code Section 1548. See LIC 809D and LIC 421FC for details.

An exit interview was conducted with the Administrator. A copy of the Facility Evaluation Report, LIC 809D, LIC 421FC (Civil Penalty), and Appeal Rights were provided.

NAME OF LICENSING PROGRAM MANAGER: Stephanie Cifuentes
NAME OF LICENSING PROGRAM ANALYST: Jose Anguiano
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 06/13/2025

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/13/2025

LIC809 (FAS) - (06/04)

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