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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 191840975
Report Date: 11/07/2022
Date Signed: 11/07/2022 01:11:19 PM

Document Has Been Signed on 11/07/2022 01:11 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 CNTR DR. ST 500
MONTEREY PARK, CA 91754
FACILITY NAME:COMEAUX FAMILY HOMEFACILITY NUMBER:
191840975
ADMINISTRATOR:RUFFINS, PECOLAFACILITY TYPE:
735
ADDRESS:1470 W. ADAMS BLVD.TELEPHONE:
(323) 732-2424
CITY:LOS ANGELESSTATE: CAZIP CODE:
90007
CAPACITY: 15CENSUS: 8DATE:
11/07/2022
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
12:07 PM
MET WITH:Stella Ruffins - Assistant AdministratorTIME COMPLETED:
01:30 PM
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Licensing Program Analyst(s) (LPA) Mary Flores conducted a plan of correction visit (POC) to follow up deficiencies given on 10/25/22. LPA Flores met with Stella Ruffins Assistant Administrator and explained the reason for the visit.

On 10/25/22 LPA Flores conducted an unannounced annual visit and noted the following deficiencies:

Section CCR 80087(a)(1) Building and Grounds -. During the visit on 10/25/22 LPAs observed bedbugs in room #4(R4). On 11/7/22 LPA observed beds in R4 have been removed and change. Assistant administrator has done 2 quotes to obtain service. An extension has been requested by the Assistant administrator to sign a contract, and receive first service by 11/28/22.

Section CCR 80088(d) Fixtures, Furniture, Equipment, and Supplies -. During the visit on 10/25/22 LPA observed light fixture in bathroom #3(B3) was not in working. On 11/7/22 LPA observed a sensor light was installed. Deficiency cleared as of 11/7/22.

Section CCR 80088(e)(1) Fixtures, Furniture, Equipment, and Supplies -. During the visit on 10/25/22 LPA tested water temperature in bathroom #2(B2) at 73.0 degrees F., which is not within the required 105-120 degrees F. On 11/7/22 water temperature was tested at 108.5 degrees F., which is within the required 105 - 120 degrees F. Deficiency cleared as of 11/7/22.

Section CCR 85087(a)(3) Building and Grounds -. During the visit on 10/25/22 a bed was observed in dining room for staff. On 11/7/22 LPA observed the bed in dining room which per the assistant administrator is being used as a sofa. No pillows and no personal items were observed in the bed. Deficiency cleared as of 11/7/22.

(CONTINUED ON LIC 809C)
SUPERVISORS NAME: Stefanie Coronel
LICENSING EVALUATOR NAME: Mary G Flores
LICENSING EVALUATOR SIGNATURE: DATE: 11/07/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/07/2022
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
CCLD Regional Office, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754
FACILITY NAME: COMEAUX FAMILY HOME
FACILITY NUMBER: 191840975
VISIT DATE: 11/07/2022
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Section Cited CCR 85087(a)(4) Building and Grounds -. During the visit on 10/25/22 client #5's room has a walkway to staff's room. On 11/7/22 LPA observed bedroom being used by staff has been cleared and set up as a client's bedroom per facility's sketch. Deficiency cleared as of 11/7/22.

Section Cited CCR 80087(a) Building and Grounds -. During the visit on 10/25/22 living room had boxes on top of couch, bathrooms had residue and dirt, carpet had debris, R3 had a broken curtain rod and chair in disrepair. On 11/7/22 LPA observed bathroom was clean, facility was free of debris, living room sofa was cleared, and curtain rod was replaced and a rolled blind was set up in the window. Deficiency cleared as of 11/7/22.

Section CCR 80087(c) Building and Grounds -. During the visit on 10/25/22 LPA observed porch exiting from R2 has recycle boxes and a large plant blocking the exit. On 11/7/22 LPA observed recycle boxes were removed and plant was moved away from the exit door. Deficiency cleared as of 11/7/22.

Exit interview was conducted with Stella Ruffins Assistant Administrator and a copy of this report was provided.
SUPERVISORS NAME: Stefanie Coronel
LICENSING EVALUATOR NAME: Mary G Flores
LICENSING EVALUATOR SIGNATURE:

DATE: 11/07/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/07/2022
LIC809 (FAS) - (06/04)
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