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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198202392
Report Date: 09/08/2023
Date Signed: 09/08/2023 11:56:08 AM

Document Has Been Signed on 09/08/2023 11:56 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, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754
FACILITY NAME:SCR II ADULT RESIDENTIAL CAREFACILITY NUMBER:
198202392
ADMINISTRATOR:CHARLES E. MILESFACILITY TYPE:
735
ADDRESS:2325 WEST 144TH STREETTELEPHONE:
(310) 525-9461
CITY:GARDENASTATE: CAZIP CODE:
90249
CAPACITY: 6CENSUS: DATE:
09/08/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
08:45 AM
MET WITH:Maura CuarentaTIME COMPLETED:
12:00 PM
NARRATIVE
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On 9/8/2023, Licensing Program Analyst (LPA) Felisa Shirley conducted an unannounced annual required visit with a primary focus on Infection Control measures using the new CARE Inspection Tool. LPA Shirley was greeted by Staff, Maura Cuarenta, Caregiver, and was granted access. The facility is licensed for six (6) ambulatory clients between the ages of 18-59. Today’s census is 4 in care.

The facility is a one-story home located in a residential neighborhood. The facility consists of the following: three (3) resident bedrooms, two (2) bathrooms, dining area, kitchen, living room, office area and shaded patio area in the backyard.

LPA and staff toured the physical plant. LPA Shirley observed that all beds and bedding supplies were in good condition, adequate lighting provided, storage for client personal belongings was observed. Bed linens, comforters, and bath towels were adequately stocked at the time of visit. Bathrooms were found to be within Title 22 regulations and were clean and operational. The water delivered at 130.3 F degrees.

There were no obstructions on the premises or small bodies of water.

LPA observed the facility to be sanitary and appropriately furnished at the time of visit. 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 maintained properly. Facility has 2 fire extinguishers, fully charged.

Deficiencies are being cited based on LPA observations and interviews conducted in accordance with the California Code of Regulations, Title 22, Divisions 6 chapter 1, see LIC 809D.

An exit interview was conducted and a copy of this report was provided to staff, Maura Cuarenta.
SUPERVISORS NAME: Stephanie Cifuentes
LICENSING EVALUATOR NAME: Felisa Shirley
LICENSING EVALUATOR SIGNATURE: DATE: 09/08/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/08/2023
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 09/08/2023 11:56 AM - It Cannot Be Edited


Created By: Felisa Shirley On 09/08/2023 at 11:38 AM
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: SCR II ADULT RESIDENTIAL CARE
FACILITY NUMBER: 198202392

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/08/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
80088(e)(1)
Fixtures, Furniture, Equipment, and Supplies
(e) Faucets used by clients for personal care such as shaving and grooming shall deliver hot water. (1) Hot water temperature controls shall be maintained to automatically regulate temperature of hot water delivered to plumbing fixtures used by clients to attain a hot water temperature of not less than 105 degrees F (40.5 degrees C) and not more than 120 degrees F (48.8 degrees C).

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 in which water temperatures above 120 F poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 09/09/2023
Plan of Correction
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Administrator will lower the water temperatures.
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:Felisa Shirley
LICENSING EVALUATOR SIGNATURE:
DATE: 09/08/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/08/2023


LIC809 (FAS) - (06/04)
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