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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198200516
Report Date: 07/29/2023
Date Signed: 07/29/2023 03:52:24 PM

Document Has Been Signed on 07/29/2023 03:52 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:SOCIAL VOCATIONAL SERVICES LOMITA RESIDENTIAL HOMEFACILITY NUMBER:
198200516
ADMINISTRATOR:SHARON HOPPERFACILITY TYPE:
735
ADDRESS:24512 WOODWARD AVENUETELEPHONE:
(310) 517-0960
CITY:LOMITASTATE: CAZIP CODE:
90717
CAPACITY: 6CENSUS: 3DATE:
07/29/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:40 AM
MET WITH:Sharon HopperTIME COMPLETED:
03:38 PM
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On 07/29/23, Licensing Program Analyst (LPA) Ernand Dabuet conducted a unannounced annual required visit using the CARE Inspection Tool. LPA met with administrator Sharon Hopper. The facility is licensed to operate for (6) Developmentally Disabled 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: (3) client's rooms, (2) bathrooms, a living area, a dining area, a kitchen, an outside seating area, and a garage used for storage.

LPA toured the physical plant. There were no bodies of water on the premises. All rooms were inspected. Beds and bedding supplies were in operational condition, lighting was provided, and storage for the client's personal belongings was observed. Bed linens, comforters, and bath towels were available during the visit. Bathrooms were operational with water temperature measured at 105.4 degrees F. A comfortable temperature of 72 F. degrees was maintained in the facility.

LPA observed the facility to be furnished at the time of the visit. Storage areas for personal hygiene and sharps objects were stored and not accessible to clients. The kitchen was inspected, and sufficient perishable and non-perishable food was maintained adequately. A fire extinguisher was charged. A review of the Medication Records Administration (MAR) was observed to be maintained in place.

During the visit, LPA observed the facility's infection control practices. LPA observed screening protocols for visitors, staff, and residents, and sanitizing stations in common areas and restrooms. LPA observed the facility has a 30-day supply of Personal Protective Equipment (PPE). All mandated inspection control posters were posted. The facility maintains an Emergency Food Supply.

Evaluation Report continues LIC 9099-C
SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Ernand Dabuet
LICENSING EVALUATOR SIGNATURE: DATE: 07/29/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/29/2023
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: SOCIAL VOCATIONAL SERVICES LOMITA RESIDENTIAL HOME
FACILITY NUMBER: 198200516
VISIT DATE: 07/29/2023
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LPA observed First Aid Kit was maintained. A working landline phone was operational. The last fire drill was conducted on 05/23/23. The facility had operational smoke and carbon monoxide in bedrooms and common areas. The facility maintains a Surety Bond on file.

An audit of client#1-#3 (C1-C3) service files and staff #1-#3 (S1-S3) personnel files revealed to be complete. An audit of the resident's P&I is maintained in order and complete. The facility has a current Administrators Certificate renewal and in pending status for Sharon Hopper #6019554735.

No deficiencies during this inspection visit.

An exit interview was conducted with Sharon Hopper, and a copy of the report was provided.
SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Ernand Dabuet
LICENSING EVALUATOR SIGNATURE:

DATE: 07/29/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/29/2023
LIC809 (FAS) - (06/04)
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