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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 191671053
Report Date: 05/02/2023
Date Signed: 05/02/2023 01:37:41 PM

Document Has Been Signed on 05/02/2023 01:37 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:GAMIO GROUP HOMEFACILITY NUMBER:
191671053
ADMINISTRATOR:GAMIO, CLAUDIAFACILITY TYPE:
735
ADDRESS:21528 RONAN AVE.TELEPHONE:
(310) 834-3918
CITY:CARSONSTATE: CAZIP CODE:
90745
CAPACITY: 6CENSUS: 3DATE:
05/02/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:20 AM
MET WITH:Claudia GamioTIME COMPLETED:
02:00 PM
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On 05/02/23, Licensing Program Analyst (LPA) Perry Scott conducted an unannounced annual required visit using the new CARE Inspection Tool. LPA met with licensee, Claudia Gamio and explained the purpose of today’s visit. The facility is licensed to operate for six (6) ambulatory clients ages 18 through 59. Currently the facility has (3) clients. The clients are Harbor Regional Center consumers. 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 two-story structure located in a residential neighborhood. It consists of the following: four (4) client bedrooms, (2) staff bedrooms, two (2) client bathrooms, (1) staff bathroom, living area, dining area, kitchen, and outside patio area. All required postings were posted throughout the facility.

LPA conducted a records review of (3) client records, (4) staff records, (3) 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 (3) Client Medication Administration Records and did not observe any discrepancies at the time of visit.

Evaluation Report Continues on LIC 809-C

SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Perry Scott
LICENSING EVALUATOR SIGNATURE: DATE: 05/02/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/02/2023
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: GAMIO GROUP HOME
FACILITY NUMBER: 191671053
VISIT DATE: 05/02/2023
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LPA toured the physical plant. There were no bodies of water or obstructions on the premises. All rooms were inspected. Beds and bedding supplies were in good condition, adequate lighting provided, storage for client personal belongings was observed. Bed linens, comforters, and bath towels were adequately stocked at the time of visit. Bathrooms were found to be within Title 22 regulations and were clean and operational. The water temperature measured 117.1 F.

LPA observed the facility appropriately furnished at the time of visit. Storage areas for cleaning supplies, toxins, and sharp objects were stored and inaccessible to clients. The kitchen was inspected, the stove and refrigerator were operable. LPA observed that there is sufficient perishable and non-perishable food available and maintained properly. Several fire extinguishers were charged, smoke detectors and carbon monoxide were operable. LPA observed the last fire/emergency drill was performed on 03/11/23.

During the visit, LPA observed the facility's infection control practices. LPA observed screening protocols for visitors, staff, and clients. LPA also observed sanitizing stations in common areas and restrooms. LPA observed the facility has a 30-day supply of Personal Protective Equipment (PPE). All mandated inspection control posters were posted.

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, and a copy of this report was provided to Claudia Gamio.
SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Perry Scott
LICENSING EVALUATOR SIGNATURE:

DATE: 05/02/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/02/2023
LIC809 (FAS) - (06/04)
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