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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197803288
Report Date: 11/25/2023
Date Signed: 11/25/2023 11:02:44 PM


COMPREHENSIVE INSPECTION

Document Has Been Signed on 11/25/2023 11:02 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:RIDGEWOOD HOMEFACILITY NUMBER:
197803288
ADMINISTRATOR:EILEEN CORREOS-VAZQUEZFACILITY TYPE:
735
ADDRESS:1072 EAST RIDGEWOOD STREETTELEPHONE:
(562) 627-9612
CITY:LONG BEACHSTATE: CAZIP CODE:
90807
CAPACITY: 4CENSUS: 4DATE:
11/25/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:04 AM
MET WITH:Eileen Vasquez & Luz RascoTIME COMPLETED:
02:25 PM
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On 11/25/23, Licensing Program Analyst (LPA) Ernand Dabuet conducted an unannounced annual required visit using the CARE Inspection Tool. LPA met with care staff Mechi Velsa. Velsa contacted Luz Rasco and Eileen Vasquez administrators by telephone who later join the visit. LPA explained the purpose of today’s visit. The facility is licensed to operate for four (4) ambulatory adults ages 18 through 59. The clients are Harbor Regional Center consumers.

The facility is a single-story structure located in a residential neighborhood. It consists of the following: four (4) clients' rooms, two (2) bathrooms, a living area, a dining area, a kitchen, and an outside patio area.

LPA toured the physical plant. There were no bodies of water or obstructions on the premises. All rooms were inspected. Beds and bedding supplies were in good condition, adequate lighting was provided, and storage for the client's personal belongings was observed. 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. A water temperature of 105.0 degrees F. A comfortable temperature of 71 degrees F. was maintained in the facility.

LPA observed the facility to be sanitary and appropriately furnished during the visit. Storage areas for personal hygiene, cleaning supplies, toxins, and sharps objects were stored and not accessible to clients. The kitchen was inspected and there is sufficient perishable and non-perishable food available and maintained adequately. The fire extinguishers were charged, and smoke detectors and carbon monoxide were operable. A review of Medication Records Administration (MAR) and Fire Drills were observed to be maintained in order and accurate. The facility conducted Fire/Safety Drill on 09/17/23. The facility has a working landline telephone. The staff had all current CPR/First Aid Training on file. The facility has current liability insurance.
Evaluation Report Continues on LIC 809-C
SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Ernand Dabuet
LICENSING EVALUATOR SIGNATURE: DATE: 11/25/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/25/2023
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754
FACILITY NAME: RIDGEWOOD HOME
FACILITY NUMBER: 197803288
VISIT DATE: 11/25/2023
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During the visit, LPA observed the facility's infection control practices. LPA observed staff followed screening protocols for visitors, staff, and residents, sanitizing stations in common areas and restrooms. LPA observed the facility has a 30-day supply of Personal Protective Equipment (PPE). Posters mandated for inspection control were posted.

An audit of clients #1-#4 (C1-C4) service records and staff #1-#5 (S1-S5) personnel records revealed to be complete. Interviews conducted with (4) clients and (2) staff. A review of client's P&I found to be maintained in order and accurate. The facility has a current surety bond coverage. The facility is current on CCL annual dues.

Deficiencies:
  • During plant inspection at 10:43am -10:50am, LPA observed client #2 and client #4 had non-operatble smoke detectors.
  • Staff #2 has been employed since 06/04/23 has a criminal clearance background, however, is not associated to the facility.

According to the California Code of Regulations (Title 22, Division 6, Chapter 1), the following deficiencies has been observed and citation issued (ref. LIC 9099-D).

An exit interview conducted with Luz Rasco and a copy of report and appeal rights provided.

Note: *Citations not cleared by the due date will be a $100 fine assessed for each citation until it is cleared. Civil penalties will continue to accrue until Proof of Corrections (POC) are cleared. *

SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Ernand Dabuet
LICENSING EVALUATOR SIGNATURE:

DATE: 11/25/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/25/2023
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 11/25/2023 11:02 PM - It Cannot Be Edited


Created By: Ernand Dabuet On 11/25/2023 at 01:38 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
, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754

FACILITY NAME: RIDGEWOOD HOME
FACILITY NUMBER: 197803288

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/25/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
11/26/2023
Section Cited
CCR
80087(a)

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80087 Buildings and Grounds (a) The facility shall be clean, safe, sanitary and in good repair at all times for the safety and well-being of clients, employees and visitors.

This requirement is not met as evidence:
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The licensee/administrator will purchase a new working smoke detector. Proof of correction is due by POC date: 11/26/23 sent by fax to (424) 544-1016.
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Based on observation, the licensee did not comply with the section. LPA identified a non-working smoke detectors for client #2 & client #4 rooms. This violaton poses an immediate health, safety or personal rights risk to persons in care.
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Type A
11/26/2023
Section Cited
CCR80087(f)(1)

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80019 Criminal Record Clearance (f) A licensee or applicant for a license may request a transfer of a criminal record clearance from one state licensed facility to another... (1) A signed Criminal Background Clearance Transfer Request, LIC 9182.
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The licensee/administrator will immediately fill out Criminal Clearance Transfer LIC 9182 for staff #2. Proof of correction is due by POC date: 11/26/23 sent by fax to (424) 544-1016.
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This requirement is not met as evidence:
Based on record review, the licensee did not comply with the section. LPA identified staff #2 is not associated through Guardian nor did not have LIC 9182. This violaton poses an immediate health, safety or personal rights risk to persons in care.
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Immediate Civil Penalty
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:Ernand Dabuet
LICENSING EVALUATOR SIGNATURE:
DATE: 11/25/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/25/2023


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