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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198202852
Report Date: 05/05/2023
Date Signed: 05/05/2023 04:03:55 PM

Document Has Been Signed on 05/05/2023 04:03 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:HI-HOPES, INCFACILITY NUMBER:
198202852
ADMINISTRATOR:HAI NGUYENFACILITY TYPE:
735
ADDRESS:16321 HAAS AVENUETELEPHONE:
(310) 808-0994
CITY:TORRANCESTATE: CAZIP CODE:
90504
CAPACITY: 6CENSUS: 4DATE:
05/05/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:11 PM
MET WITH:Melonie SuarezTIME COMPLETED:
04:30 PM
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On 5/05/23 Licensing Program Analyst (LPA) Antonine Richard conducted an unannounced annual required visit using the New Care Inspection Tool. LPA was met with Supervisor Melonie Suarez and explained the purpose of today's visit.

There are currently (4) 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 detached garage.

LPA and Supervisor toured the entire facility inside and out. Documents are posted as mandated by the DPH and CCLD. Bedrooms 1 – 4 are occupied by clients and contain the mandated furniture. The (2) bathrooms are clean and operational. Smoke detectors and carbon monoxide detector are in compliance and operational. No firearms are stored at facility and no bodies of water present. Medications are stored, locked and inaccessible to clients. All staff files, and resident files are current along with medications. The hot water temperature in the bathroom tested at 109.6F degrees. A comfortable temperature is maintained throughout the facility. The kitchen was inspected there is sufficient perishable and nonperishable food available and maintained properly. Linens and personal hygiene supplies adequate. hazardous toxins and/or items are inaccessible to clients, 2 fire extinguishers are 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. During the visit, LPA observed the facility infection control practices. LPA observed a sanitizing station at the facility entry, sanitizer/soap in the staff bathroom and additional sanitation supplies in a locked cabinet located in the garage. LPA observed staff and clients wearing masks, clients can isolate in their room if necessary required postings throughout the facility.

SUPERVISORS NAME: Ulysses Coronel
LICENSING EVALUATOR NAME: Antonine Richard
LICENSING EVALUATOR SIGNATURE: DATE: 05/05/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/05/2023
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: HI-HOPES, INC
FACILITY NUMBER: 198202852
VISIT DATE: 05/05/2023
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The administrator advised LPA that sanitizer is administered to client with the supervision of staff, but sanitizers are not kept in their rooms for safety reasons. The facility has an approved Mitigation plan staff has been N95 fit tested. Visitors are logged and checked. The client’s temperatures are checked and logged 2x a day.

According to the California Code of Regulations (Title 22, Division 6, Chapter 8), LPA did not observe any deficiencies, therefore no citations were issued at this time.

An exit interview was conducted and a copy of this report was provided to Supervisor Melonie Suarez.

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

DATE: 05/05/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/05/2023
LIC809 (FAS) - (06/04)
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