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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197608484
Report Date: 09/28/2022
Date Signed: 09/28/2022 02:50:05 PM

Document Has Been Signed on 09/28/2022 02:50 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
MONTEREY PARK, CA 91754
FACILITY NAME:GOOD COMPANY RESIDENTIAL CARE LLC.FACILITY NUMBER:
197608484
ADMINISTRATOR:LA DONNA R. GOODFACILITY TYPE:
735
ADDRESS:3240 GREENFIELD AVENUETELEPHONE:
3109045969
CITY:LOS ANGELESSTATE: CAZIP CODE:
90034
CAPACITY: 4CENSUS: 3DATE:
09/28/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:44 AM
MET WITH: Director, La Donna Good TIME COMPLETED:
03:00 PM
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On 9/28/2022, Licensing Program Analyst (LPA) Antonia Alvizar conducted an unannounced annual required visit with a primary focus on Infection Control measures using the new CARE Inspection Tool visit to Good Company Residential Care LLC. The purpose of today’s visit was to conduct the annual inspection

Upon arriving at the facility, LPA met with Direct Support Staff (DSP), Timithy Bellholzinger. LPA was granted access and allowed to enter facility to conduct an annual inspection. Director La Donna Good joined the visit shortly after. The residents receive services from the Westside Regional Center. The home is licensed to serve up to (4) four ambulatory residents.

During today’s visit LPA toured the single- story physical plant with DSP, Timithy the home consists of (3) three bedrooms, (2) two bathrooms, dining room, living room, kitchen, and washer and dryer in hallway closet and shaded area in the backyard. The front and backyard are well maintained and there are no pools or large bodies of water. Passageways and exits are free of obstruction. There is sufficient lighting throughout the home. The water temperature was tested in kitchen, both bathrooms and measured between 117.0F - 119.2F which is within Title 22 Regulations.



Resident bedrooms had the required furniture, bed linens and closet/drawer space to accommodate each resident comfortably. Resident bathrooms were checked. Toilets and water faucets worked properly, shower was free of mold/mildew and a non-skid mat was in place. Resident bath towels, toiletries and personal hygiene supplies were adequately stocked. Common areas were clean; doorways were free of obstructions.

Continued on 809C
SUPERVISORS NAME: Ulysses Coronel
LICENSING EVALUATOR NAME: Antonia Alvizar
LICENSING EVALUATOR SIGNATURE: DATE: 09/28/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/28/2022
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 DR #100
MONTEREY PARK, CA 91754
FACILITY NAME: GOOD COMPANY RESIDENTIAL CARE LLC.
FACILITY NUMBER: 197608484
VISIT DATE: 09/28/2022
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Each bedroom has a smoke detector which were tested and operable during the visit. Carbon monoxide detectors are intertwined with the smoke detectors and are operable. There is a fire extinguisher located in the dining room. Kitchen appliances are clean and were operating at the time of the visit. Sharp items are locked and inaccessible to residents. Cleaning solutions are locked in a cabinet. Kitchen was checked LPA Alvizar observed an adequate supply of perishable, non-perishable food and stored properly. The medications are stored in a locked cabinet located in the living room. First Aid kit was available with a pair of scissor, tweezer, and thermometer. Facility is operating within the approved capacity. Facility last fire drill was conducted on 9/2/2022. There are no weapons on the premises.

Per California Code of Regulations, Title 22, and California Health and Safety Code, there were no deficiencies observed during the visit. Exit interview held and a copy of the report was provided to Director, La Donna Good.
SUPERVISORS NAME: Ulysses Coronel
LICENSING EVALUATOR NAME: Antonia Alvizar
LICENSING EVALUATOR SIGNATURE:

DATE: 09/28/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/28/2022
LIC809 (FAS) - (06/04)
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