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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198202852
Report Date: 05/23/2024
Date Signed: 05/23/2024 03:35:21 PM

Document Has Been Signed on 05/23/2024 03:35 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 ASC, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245
FACILITY NAME:HI-HOPES, INCFACILITY NUMBER:
198202852
ADMINISTRATOR/
DIRECTOR:		HAI NGUYENFACILITY TYPE:
735
ADDRESS:16321 HAAS AVENUETELEPHONE:
(310) 808-0994
CITY:TORRANCESTATE: CAZIP CODE:
90504
CAPACITY: 6CENSUS: 4DATE:
05/23/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:19 PM
MET WITH:Mariel VenturaTIME VISIT/
INSPECTION COMPLETED:
03:50 PM
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On 05/23/24, Licensing Program Analyst (LPA) Antonine Richard conducted an unannounced annual required visit using the New Care Inspection Tool. LPA was met with Administrator Mariel Ventura and later was joined 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 administrator 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 110.6F degrees. A comfortable temperature is maintained throughout the facility.

SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Antonine Richard
LICENSING EVALUATOR SIGNATURE: DATE: 05/23/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/23/2024
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, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245
FACILITY NAME: HI-HOPES, INC
FACILITY NUMBER: 198202852
VISIT DATE: 05/23/2024
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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, 1 fire extinguisher is fully charged. First Aid kit complete and with manual. The last fire drill was conducted on 05/11/24. Exit walkways and/or passageways, front and back yard are free of debris and/or hazards. The facility is in good repair. The facility has an approved Mitigation plan, visitors are logged and checked. The facility fees are current.

No deficiencies cited. Exit interview was conducted and a copy of this report was provided to the Administrator Mariel Ventura

SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Antonine Richard
LICENSING EVALUATOR SIGNATURE:

DATE: 05/23/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/23/2024
LIC809 (FAS) - (06/04)
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