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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198201918
Report Date: 06/12/2023
Date Signed: 06/12/2023 04:38:23 PM

Document Has Been Signed on 06/12/2023 04:38 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:CHALLENGE ONE ARFFACILITY NUMBER:
198201918
ADMINISTRATOR:GIL TEELFACILITY TYPE:
735
ADDRESS:500 W. HILLSDALE STREETTELEPHONE:
(323) 815-9881
CITY:INGLEWOODSTATE: CAZIP CODE:
90302
CAPACITY: 4CENSUS: 4DATE:
06/12/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:51 PM
MET WITH:DILLON RANDOLPHTIME COMPLETED:
05:00 PM
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On 06/12/2023 Licensing Program Analyst (LPA) Antonine Richard conducted an unannounced Annual required visit using the Care Inspection Tool. LPA was met by Erika Scales, and later met with Randolph Dillon, Administrator and the purpose of today’s visit was explained.

There are currently (4) West-Side Regional Center consumers in placement. All (4) clients are ambulatory. The facility is a single-story structure located in a residential neighborhood. It consists of the following: 4 bedrooms, 2 bathrooms, family room/office, living room, kitchen, dining room, shaded area, indoor and outdoor activity area, laundry room and a detached garage.

LPA and Erika & Esther (care givers) toured the entire facility inside and out. Documents are posted as mandated by the DPH and CCLD. Bedrooms 1-4 (A, B, C, & D) are occupied by clients and contain the mandated furnisher. The (2) bathrooms are clean and operational. Smoke detectors and carbon monoxide detector comply and are operational. No firearms are stored at facility and no bodies of water present. Medications are stored, locked and inaccessible to clients. All staff and resident files were reviewed. Medications, and P&I money is current and complete. The water temperature is at 109.3F Degrees Fahrenheit. A comfortable temperature is maintained in the facility. Ample supply of perishable and nonperishable food, linens and personal hygiene supplies are adequate, hazardous toxins and/or items are inaccessible to clients, (1) fire extinguishers is fully charged. First Aid kit complete and with manual. Exit, walkways and/or passageways, front and back yard are free of debris and/or hazards. The facility is in good repair.

SUPERVISORS NAME: Ulysses Coronel
LICENSING EVALUATOR NAME: Antonine Richard
LICENSING EVALUATOR SIGNATURE: DATE: 06/12/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/12/2023
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: CHALLENGE ONE ARF
FACILITY NUMBER: 198201918
VISIT DATE: 06/12/2023
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During the visit, LPA observed the facility infection control practices. LPA observed a sanitizing station at the facility entry, sanitizer/soap in all bathrooms, and additional sanitation supplies stored in a shed in the back yard. LPA observed staff and clients wearing masks, clients room will be isolation rooms, if needed. Required postings throughout the facility. Trash can with lids, Carts with PPE’s. The facility has an approved Mitigation plan. Visitors are logged and temperatures checked. The client’s temperatures are checked and logged 2x a day.

No deficiencies were cited during this inspection visit.

An exit interview was conducted and a copy of this report was provided to Administrator Rondolph Dillon

SUPERVISORS NAME: Ulysses Coronel
LICENSING EVALUATOR NAME: Antonine Richard
LICENSING EVALUATOR SIGNATURE:

DATE: 06/12/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/12/2023
LIC809 (FAS) - (06/04)
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