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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 191670135
Report Date: 12/30/2024
Date Signed: 12/31/2024 07:23:05 AM

Document Has Been Signed on 12/31/2024 07:23 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 ASC, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245
FACILITY NAME:TAYLOR'S RESIDENTIAL CAREFACILITY NUMBER:
191670135
ADMINISTRATOR/
DIRECTOR:		TAYLOR, DELETHAFACILITY TYPE:
735
ADDRESS:1037 EAST GLADWICKTELEPHONE:
(310) 638-8887
CITY:CARSONSTATE: CAZIP CODE:
90746
CAPACITY: 6CENSUS: 4DATE:
12/30/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:08 AM
MET WITH:Deletha Taylor, AdministratorTIME VISIT/
INSPECTION COMPLETED:
01:45 PM
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On 12/30/2024 at 11:08am, Licensing Program Analyst (LPA) Zina Brown conducted an unannounced annual required visit using the CARE Inspection Tool. LPA met with the Deletha Taylor, Administrator and the purpose of today’s visit was explained. The facility is licensed to operate for (6) ambulatory developmentally disabled adults ages 18 through 59. Currently, the home has (4) clients. The clients are South Central Los Angeles Regional Center clients. The facility fee balance is $0..

The facility is a one (1) story home located in a residential neighborhood. The property consists of the following: 4 client bedrooms, 2 common bathrooms, staff office, living room, kitchen, dining room, attached garage which houses (2) additional refrigerators, a washer and a dryer and an outdoor shaded area.

LPA conducted a records review of (4) client records, (4) staff records, (3) Client Medication Administration Records and (0) clients Personal & Incidental Records and reviewed the facility disaster plan. All client & staff records were completed. The facility disaster plan was current and in compliance with Title 22 at the time of visit. The last disaster/fire drill was conducted on 12/25/2024.

At 11:15 am, LPA and Ana Ruth Ortega (Director Support Specialist) toured the inside and outside of the facility. All client rooms were checked. Mattresses and box springs were in good condition, adequate lighting was observed , plenty of dresser and closet space was observed. Walls and floors were clean and in good repair. Bed linens, comforters and bath towels were adequately stocked at the time of visit. Bathrooms were found to be within Title 22 regulation. Toilets and water faucets worked properly. Shower was free of mold/mildew, there is adequate lighting, and sufficient toiletries accessible to clients. The water temperature properly measured between 105-120F (Kitchen 112.6 F, Bathroom #1 -106.3F & Bathroom #2 - 113.2F).

Report continue on LIC 809-C

SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Zina Brown
LICENSING EVALUATOR SIGNATURE: DATE: 12/30/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/30/2024
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 ASC, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245
FACILITY NAME: TAYLOR'S RESIDENTIAL CARE
FACILITY NUMBER: 191670135
VISIT DATE: 12/30/2024
NARRATIVE
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Perishable and non-perishable food supply was checked and adequately stocked at time of visit. Carbon monoxide detector was observed and operational. Smoke detectors were working properly, fire extinguishers were fully charged, toxins and knifes were locked and inaccessible to clients. Medications were centrally stored and properly locked, first aid kit was checked and fully stocked. Outside grounds were toured and no bodies of water were observed. Exits/ Walkways around the home were free of debris and hazards.

During todays visit LPA did observe a deficiency.

LPA observed the following not in compliance:
On 12/30/2024, LPA reviewed Staff #4 file and observed there was no criminal record association at the time of visit. According, administrator, staff Esperenza Sanchez has years of experience working at another other facilities.

Civil Penalty assessed.

Deficiencies Cited Under California Code of Regulations Title 22, Division 6, Chapter 3.


Exit interview conducted with Deletha Taylor, Administrator and a copy of the appeal rights were given.
SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Zina Brown
LICENSING EVALUATOR SIGNATURE:

DATE: 12/30/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/30/2024
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Document Has Been Signed on 12/31/2024 07:23 AM - It Cannot Be Edited


Created By: Zina Brown On 12/30/2024 at 01:17 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: TAYLOR'S RESIDENTIAL CARE
FACILITY NUMBER: 191670135

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/30/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
80019(e)
Criminal Record Clearance
(e) All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1522 shall prior to working, residing or volunteering in a licensed facility:

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation and interview, staff Esperanza Sanchez was not associated to the facility at the time of unannouced inspection which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 12/31/2024
Plan of Correction
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The facility shall associate staff in Guardian and submit proof of update via email zina.brown@dss.ca.gov by POC due date.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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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:Zina Brown
LICENSING EVALUATOR SIGNATURE:
DATE: 12/30/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/30/2024


LIC809 (FAS) - (06/04)
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