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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197801989
Report Date: 01/28/2023
Date Signed: 02/26/2023 04:45:10 PM

Document Has Been Signed on 02/26/2023 04:45 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:GARDEN, THEFACILITY NUMBER:
197801989
ADMINISTRATOR:GRAY, ROSLYNFACILITY TYPE:
735
ADDRESS:2485 CEDAR AVE.TELEPHONE:
(562) 492-9833
CITY:LONG BEACHSTATE: CAZIP CODE:
90806
CAPACITY: 4CENSUS: 2DATE:
01/28/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:ROSLYN GRAY TIME COMPLETED:
03:57 PM
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On 02/26/23 Licensing Program Analyst (LPA) Ernand Dabuet conducted an unannounced Annual required visit with a primary focus on infection control measures. LPA was met by Roslyn Gray, administrator, and explained the purpose of today’s visit. The facility is licensed to serve 4 developmentally disabled clients 18 thru 59 years; ambulatory only, with restricted health conditions.

There are currently (2) Harbor Regional Center clients in placement. The facility is a single-story structure located in a residential neighborhood. The home consists of (2) Client Bedrooms, (3) Bathrooms (1) staff room, a living room, a kitchen, and a dining-room. LPA toured the physical plant. There are no bodies of water or firearm/ammunition on the premises. All client rooms were checked. Beds and bedding were in good condition, adequate lighting was provided, and storage for the client's personal belongings was observed. The walls and floors were in good repair. Bed linens, comforters, and bath towels were adequately stocked at the time of the visit. Bathrooms were found to be within Title 22 regulations and were clean and operational. The water temperature measured 107.3 F. A comfortable temperature is maintained in the facility. LPA observed the facility to be clean and appropriately furnished at the time of the visit. Storage areas for personal hygiene, cleaning agents, toxins, and sharps were inaccessible to clients. The kitchen was inspected and there is enough non-perishable food available which is stored properly. A fire extinguisher was charged, and smoke detectors and Carbon Monoxide were operable. The facility has several working landline phones. A review of Medication Administration Records (MAR) and P&I records was maintained in order. During the visit, LPA observed the facility's infection control practices. LPA observed screening protocols for visitors, staff, and residents, sanitizing stations located in common areas and restrooms). LPA observed staff and residents were wearing face coverings, in an isolation room and required postings throughout the facility. LPA observed the facility has a 30-day supply of Personal Protective Equipment (PPE). (No deficiencies cited)

An exit interview was conducted and a copy of the report was provided to Roslyn Gray.
SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Ernand Dabuet
LICENSING EVALUATOR SIGNATURE: DATE: 01/28/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/28/2023
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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