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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197608484
Report Date: 08/22/2024
Date Signed: 10/24/2024 07:06:22 PM

Document Has Been Signed on 10/24/2024 07:06 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 ASC, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245
FACILITY NAME:GOOD COMPANY RESIDENTIAL CARE LLC.FACILITY NUMBER:
197608484
ADMINISTRATOR/
DIRECTOR:
LA DONNA R. GOODFACILITY TYPE:
735
ADDRESS:3240 GREENFIELD AVENUETELEPHONE:
(310) 904-5969
CITY:LOS ANGELESSTATE: CAZIP CODE:
90034
CAPACITY: 4CENSUS: 3DATE:
08/22/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:11 PM
MET WITH:Deshaun BellTIME VISIT/
INSPECTION COMPLETED:
03:45 PM
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On 08/22/24, Licensing Program Analyst (LPA) Sparkle Day conducted an unannounced annual required visit using the CARE In spection Tool. LPA met with Deshaun Bell, DSP and was later joined by Administrator ( LaDonna Good) and the purpose of today’s visit was explained. The facility is licensed to operate for (4) ambulatory only developmentally disabled adults ages 18 through 59. Currently, the home has (3) clients. The clients are (Westside Regional Center clients. None of the clients have Restricted Health Care Conditions, and none are utilizing postural supports or protective devices.

The facility is a one family home located in a residential neighborhood. The property consists of the following: 3 client bedrooms, 2 common bathrooms, living room, kitchen, dining room and attached garage. The washer and dryer is located in the hallway of the home. There is an outdoor shaded area.

LPA conducted a records review of (3) client records, (3) 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.

At 1:55 pm LPA and (Deshaun Bell) 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 120.

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 not observe any deficiencies.

Exit interview conducted with LaDonna Good, Administrator.

SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Sparkle Day
LICENSING EVALUATOR SIGNATURE: DATE: 08/22/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/22/2024
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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