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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198202233
Report Date: 01/19/2023
Date Signed: 01/19/2023 04:18:56 PM

Document Has Been Signed on 01/19/2023 04:18 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:DENKER HOUSEFACILITY NUMBER:
198202233
ADMINISTRATOR:GREG SWIFTFACILITY TYPE:
735
ADDRESS:20902 DENKER AVENUETELEPHONE:
(310) 212-6721
CITY:TORRANCESTATE: CAZIP CODE:
90501
CAPACITY: 9CENSUS: 9DATE:
01/19/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:30 AM
MET WITH:Carol Liess/Philip Guaglianone/Leticia PachecoTIME COMPLETED:
04:30 PM
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On 1/19/2023, Licensing Program Analyst (LPA) Lourdes Montoya conducted an unannounced required annual visit with a primary focus on Infection Control measures using the new CARE Inspection Tool. Upon arrival, LPA called the facility to conduct a risk assessment with House Manager Leticia Pacheco. Based on the assessment, the facility is clear of Covid-19 infection. LPA met with House Manager Leticia Pacheco and explained the purpose of the visit. Case Manager Philip Guaglianone and Administrator Carol Liess arrived later and joined the visit.

The facility is approved to serve (nine) 9 ambulatory adults with a mental health diagnosis. Currently, the census for client is nine (9) and staff census is three (3). LPA verified that the facility has an approved mitigation plan report.

LPA and House Manager Pacheco toured the inside and outside grounds of the facility. There were no bodies of water or obstructions on the premises. All rooms were inspected and had adequate lighting and furnishings. A comfortable temperature was maintained in the facility. There are three (3) fire extinguishers last serviced on 1/25/2022. The last fire drill was conducted on 12/30/2022. Smoke alarm system was tested and found to be operable. The water temperature was measured at 115.9 degree Fahrenheit. Medications are locked & centrally stored in a locked room. The first aid kit has all required supplies.

During the visit, LPA observed the following to be in compliance: the facility's infection control practices; screening protocols for visitors, staff, and clients, sanitizing stations in common areas and restrooms; every staff was wearing a face covering; facility has a 30-day supply of Personal Protective Equipment (PPE). All mandated inspection control posters were posted. LPA requested a copy of facility's liability insurance. LPA observed several other facilities are listed on the certificate. LPA will verify is the insurance coverage is sufficient.



Report continued in LIC 809C
SUPERVISORS NAME: Stephanie Cifuentes
LICENSING EVALUATOR NAME: Lourdes Montoya
LICENSING EVALUATOR SIGNATURE: DATE: 01/19/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/19/2023
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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Document Has Been Signed on 01/19/2023 04:18 PM - It Cannot Be Edited


Created By: Lourdes Montoya On 01/19/2023 at 02:55 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: DENKER HOUSE
FACILITY NUMBER: 198202233

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/19/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
80087(a)
Building 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 evidenced by:
Deficient Practice Statement
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Based on observation, the licensee did not comply with the section cited above. LPA Montoya observed the floors in the kitchen, dining room and second story of the home is dirty. LPA observed dust, embedded soil or dirt underneath the kitchen cabinets and around the floor edges of the room. LPA observed the bathroom next to the kitchen and the back door is dirty. LPA observed feces around the toilet bowl and on the floor. This poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 01/30/2023
Plan of Correction
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The administrator shall ensure the facility is always clean. POC shall be submitted to CCLD via email to lourdes.montoya@dss.ca.gov by the POC due date. The administrator refused to sign the LIC 809D page.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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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:Stephanie Cifuentes
LICENSING EVALUATOR NAME:Lourdes Montoya
LICENSING EVALUATOR SIGNATURE:
DATE: 01/19/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/19/2023


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: DENKER HOUSE
FACILITY NUMBER: 198202233
VISIT DATE: 01/19/2023
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According to the California Code of Regulations (Title 22, Division 6, Chapter 1), LPA did observed a deficiency; therefore, citation is issued.

An exit interview was conducted, and a Facility Evaluation Report and Appeal Rights were provided to Administrator Carol Liess.
SUPERVISORS NAME: Stephanie Cifuentes
LICENSING EVALUATOR NAME: Lourdes Montoya
LICENSING EVALUATOR SIGNATURE:

DATE: 01/19/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/19/2023
LIC809 (FAS) - (06/04)
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