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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198202431
Report Date: 07/18/2024
Date Signed: 07/18/2024 11:48:58 AM

Document Has Been Signed on 07/18/2024 11:48 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 ASC, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754
FACILITY NAME:223RD STREET HOUSE (HFL HARBOR GATEWAY HOMES)FACILITY NUMBER:
198202431
ADMINISTRATOR/
DIRECTOR:		LIESS, CAROL MFACILITY TYPE:
735
ADDRESS:1435 W. 223RD STREETTELEPHONE:
(310) 781-9094
CITY:TORRANCESTATE: CAZIP CODE:
90501
CAPACITY: 6CENSUS: 5DATE:
07/18/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:26 AM
MET WITH:House Manager Edna DulayTIME VISIT/
INSPECTION COMPLETED:
12:05 PM
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On 07/18/2024 at 8:26 AM, Licensing Program Analyst (LPA) Regina Cloyd conducted an unannounced Required – 1 Year Inspection to the above-named facility and met with House Manager Edna Dulay. LPA explained the purpose of the visit and was accompanied by House Manager inside and outside the facility during this inspection. The facility is licensed for 6 ambulatory clients who are mentally disabled. Annual Fees are current.

The facility is a two-story home in a residential neighborhood. The facility consists of 3-client bedrooms, 3-bathrooms, staff office, staff room, living room, kitchen, dining room, and attached garage.

Outside grounds were toured and no bodies of water were observed. Patio furniture under a shaded area was accessible to clients. Walkways around the home were clear of hazards. There are no security bars or weapons on the premises.

Three (3) out of (3) client’s bedrooms were checked. Plenty of dresser and closet space observed. Comforters, bed linen, bath towels and mattress protectors were adequately stocked. Bathroom toilets and water faucets worked properly. LPA Cloyd tested hot water temperature and it measured at 105 degrees Fahrenheit. This facility provides clients with hygiene products such as nonmedicated soap, toilet paper, toothbrush, toothpaste, and comb.

Continue to LIC809-C.

SUPERVISORS NAME: Ulysses Coronel
LICENSING EVALUATOR NAME: Regina Cloyd
LICENSING EVALUATOR SIGNATURE: DATE: 07/18/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/18/2024
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 ASC, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754
FACILITY NAME: 223RD STREET HOUSE (HFL HARBOR GATEWAY HOMES)
FACILITY NUMBER: 198202431
VISIT DATE: 07/18/2024
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LPA observed supplies of nonperishable foods for a minimum of one week and fresh perishable foods for a minimum of two days.

LPA observed that Medications were safe, locked and inaccessible. All medications observed were labeled and maintained in compliance with label instructions and State and Federal law. Documents are posted as mandated. Last Disaster drill was conducted on 06/28/24. First aid kit is available. Smoke and carbon monoxide detectors were in compliance and operational.



Five (5) staff records were reviewed, 5 out of 5 staff records had required criminal record clearances or criminal record exemptions.

Five (5) client records were reviewed and, 5 out of 5 client records had Admission Agreements, Medical Assessments, Pre-appraisals (or Reappraisals) and/or Needs & Services Plans. Two client medications were reviewed. LPA Cloyd reviewed one client’s P&I money.

No deficiencies cited.

An exit interview was conducted, technical assistance provided, and a copy of this report was discussed and left with the House Manager Edna Dulay.

SUPERVISORS NAME: Ulysses Coronel
LICENSING EVALUATOR NAME: Regina Cloyd
LICENSING EVALUATOR SIGNATURE:

DATE: 07/18/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/18/2024
LIC809 (FAS) - (06/04)
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