197802808-9-13-2024-11-AS-ZBRN-D93LSG-20240913090044

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197802808
Report Date: 09/12/2024
Date Signed: 09/13/2024 09:01:19 AM

Document Has Been Signed on 09/13/2024 09:01 AM - 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:	BIENNAS HOME		FACILITY NUMBER:	197802808
ADMINISTRATOR/ DIRECTOR:	BIENNA LAPUZ		FACILITY TYPE:	735
ADDRESS:	3502 IROQUOIS AVENUE		TELEPHONE:	(562) 425-5270
CITY:	LONG BEACH	STATE: CA	ZIP CODE:	90808
CAPACITY: 4		CENSUS: 3	DATE:	09/12/2024
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	09:00 AM
MET WITH:	Sonia Lapuz, Licensee Care Provider		TIME VISIT/ INSPECTION COMPLETED:	01:30 PM

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On 09/12/2024 at 8:52am, Licensing Program Analyst (LPA) Zina Brown conducted an unannounced annual required visit using the CARE Inspection Tool. LPA met with the Sonia Lapuz, Licensee Care Provider and the purpose of today’s visit was explained. The facility is licensed to operate for (2) ambulatory, (1) non-ambulatory, (0) bedridden (developmentally disabled or Mentally Ill) adults ages 18 through 59. Currently, the home has (3) clients. The clients are Harbor Regional Center clients. None the clients have Restricted Health Care Conditions and none are utilizing postural supports or protective devices.

The facility is a two (2) story home located in a residential neighborhood. The property consists of the following: 3 client bedrooms, 1 common bathroom, 1 half bathroom, 1 staff room, a staff office, living room, kitchen, dining room, attached garage which houses the washer and dryer and an outdoor shaded area with an additional refrigerator .

At 9:10am LPA Zina Brown and Sonia Lapuz 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 105-120F ( Kitchen 105.0 F , Bathroom #105.0F, & Half Bathroom 105.0F).

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.

SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Zina Brown
LICENSING EVALUATOR SIGNATURE:	DATE: 09/12/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/12/2024

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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245

FACILITY NAME: BIENNAS HOME	FACILITY NUMBER: 197802808
	VISIT DATE: 09/12/2024

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LPA conducted a records review of (3) client records, (4) staff records, (2) 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 observed any discrepancies at the time of visit.

LPA observed the following not in compliance:
On 09/12/2024, LPA conducted a file review of staff files and did not observe an no staff training for Staff #2 - Staff #3 from 2018 - 2024.

Deficiency Cited Under California Code of Regulations Title 22, Division 6, Chapter 1.

Exit interview conducted with Sonia Lapuz, Licensee Care Provider.

SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Zina Brown
LICENSING EVALUATOR SIGNATURE:	DATE: 09/12/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/12/2024

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 09/13/2024 09:01 AM - It Cannot Be Edited

Created By: Zina Brown On 09/12/2024 at 01:02 PM

Link to Parent Document Below:

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245

FACILITY NAME: BIENNAS HOME	FACILITY NUMBER: 197802808
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 09/12/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

162

(a) The department shall ensure that operators and staffs of community care facilities have appropriate training to provide the care and services for which a license or certificate is issued. The section shall not apply to a facility licensed as an Adult Residential Facility for Persons with Special Health Care Needs pursuant to Article 9 (commencing with Section 1567.50). This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation, the licensee did not comply with the section cited above in which poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 10/12/2024
	Plan of Correction
1 2 3 4	The adminstrator will provide training for all staff by POC due date and sent proof of completed training to the department at zina.brown@dss.ca.gov by POC Due Date.

Section Cited


	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

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:

Janae Hammond

LICENSING EVALUATOR NAME:

Zina Brown

LICENSING EVALUATOR SIGNATURE:

DATE: 09/12/2024

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/12/2024

LIC809 (FAS) - (06/04)

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