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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197608050
Report Date: 11/03/2021
Date Signed: 04/26/2022 04:52:19 PM


Document Has Been Signed on 04/26/2022 04:52 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
MONTERY PARK, CA 91754



FACILITY NAME:ADORABLE HOME IIFACILITY NUMBER:
197608050
ADMINISTRATOR:JOCELYN MORALESFACILITY TYPE:
740
ADDRESS:20545 MADISON STREETTELEPHONE:
(310) 370-3748
CITY:TORRANCESTATE: CAZIP CODE:
90503
CAPACITY:6CENSUS: 6DATE:
11/03/2021
TYPE OF VISIT:Case Management - Health ChecksUNANNOUNCEDTIME BEGAN:
10:05 AM
MET WITH:JOYCELY MORALESTIME COMPLETED:
01:00 PM
NARRATIVE
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On 11/3/2021 at 10:05 am, Licensing Program Analyst (LPA) Lourdes Montoya conducted an Unannounced Case Management Health Checks visit. LPA was met by Facility Administrator/Licensee Joycelyn Morales, and the purpose of the visit was explained.

Case Management consisted of the following:
Physical Tour of facility, Review of Resident Records, and Health And Safety Check on Clients in Care.

LPA observed the following that require technical assistance.

1. Broken window glass of the garage.
2. Torn window screen in staff room.
3. Old wheelchairs and bathroom commode chairs owned by former residents stored in a locked shed.
4. Resident #1's records are not updated. All Resident #1's records need to reflect the facility's name.

According to the California Code of Regulations (Title 22, Division 6, Chapter 8), LPA observed the following deficiency and issued a citation.LPA Montoya observed an added room which measures 4' X 10' next to bedroom #3.

An exit interview was conducted, appeal rights explained and a copy of this report was provided to Administrator Joycelyn Morales..
SUPERVISOR'S NAME: Angela J KendrickTELEPHONE: (323) 629-7815
LICENSING EVALUATOR NAME: Lourdes MontoyaTELEPHONE: (323) 981-4934
LICENSING EVALUATOR SIGNATURE:
DATE: 11/03/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/03/2021
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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Document Has Been Signed on 04/26/2022 04:52 PM - It Cannot Be Edited

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 DR #100
MONTERY PARK, CA 91754


FACILITY NAME: ADORABLE HOME II
FACILITY NUMBER: 197608050

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/03/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
11/16/2021
Section Cited

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87305 Alterations to Existing Building or New Facilities (a) Prior to construction or alterations, all facilities shall obtain a building permit. This requirement was not met as evidenced by:
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Based on interview, observation, and record review the licensee failed to ensure that a permit is obtained prior to a construction. On 11/3/2021, LPA Montoya observed a bedroom which measures 4' X 10' was added next to bedroom #3. This added room has it's own door accessible from the backyard and it consists of a twin bed, a nightstand, and a small TV with a stand. This poses a potential risk to residents' health, safety and/or personal rights risk to residents 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: Angela J KendrickTELEPHONE: (323) 629-7815
LICENSING EVALUATOR NAME: Lourdes MontoyaTELEPHONE: (323) 981-4934
LICENSING EVALUATOR SIGNATURE:
DATE: 11/03/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/03/2021
LIC809 (FAS) - (06/04)
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