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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198202967
Report Date: 10/16/2024
Date Signed: 10/16/2024 08:14:50 PM

Document Has Been Signed on 10/16/2024 08:14 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:ANAND CARE CENTER IIIFACILITY NUMBER:
198202967
ADMINISTRATOR/
DIRECTOR:		MEHUL PATELFACILITY TYPE:
735
ADDRESS:11143 SOUTH PRARIE AVETELEPHONE:
(310) 419-1225
CITY:INGLEWOODSTATE: CAZIP CODE:
90303
CAPACITY: 20CENSUS: 14DATE:
10/16/2024
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:30 PM
MET WITH:Meluh Patel TIME VISIT/
INSPECTION COMPLETED:
01:45 PM
NARRATIVE
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On 10/16/24, Licensing Program Analyst (LPA) Ernand Dabuet conducted a Case Management visit at this facility. LPA met with administrator Meluh Patel and allowed entry inside this facility. LPA informed Patel the purpose of the visit is to conduct a health and safety check in association with complaint #11-AS-20241010104538.

In association with complaint #11-AS-20241010104538. LPA was informed by the administrator the facility was without hot water for several days. The city of Inglewood along with Southern California Gas company shut of the the gas effective 10/01/24 for 48 hours for the entire commercial block. The administrator stated each resident was informed that hot water would not be available through verbal notification. Staff #1 (S1) stated the residents were offer to have boiled water as option while construction was in process. Throughout the investigation Community Care Licensing (CCL) was not notified with of the hot water shut off and construction.

As a result of the LPA reviewing the work service receipt from the City of Inglewood, it revealed the facility failed to notify the Department by telephone or by fax with an Unusual Incident Report LIC 624 during Department's normal business hours.

According to the California Code of Regulations (Title 22, Division 6, Chapter 1), the following deficiencies has been observed and citation issued (ref. LIC 809-D).

An exit interview conducted with Mehul Patel and a copy of report and appeal rights provided.

Note: *Citations not cleared by the due date will be a $100 fine assessed for each citation until it is cleared. Civil penalties will continue to accrue until Proof of Corrections (POC) are cleared.

SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Ernand Dabuet
LICENSING EVALUATOR SIGNATURE: DATE: 10/16/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/16/2024
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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Document Has Been Signed on 10/16/2024 08:14 PM - It Cannot Be Edited


Created By: Ernand Dabuet On 10/16/2024 at 12:56 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
, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245

FACILITY NAME: ANAND CARE CENTER III
FACILITY NUMBER: 198202967

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/16/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
10/23/2024
Section Cited
CCR
80061(E)

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80061 (E) Any unusual incident or client absence which threatens the physical or emotional health or safety of any client.

This has not been met as evidenced by:
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Licensee/Administrator have agreed to review Title 22 Reg 80061 and submit an LIC 624 to LPA Dabuet, via email, at Ernand.Dabuet@dss.ca.gov by POC due date.
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Based on record review/interview administrator admitted that he failed to notify CCL by telephone or LIC 624 of hot water shut off. This violation which poses a potential health and safety to residents in care.
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This citation was corrected during visit with a LIC 624.

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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:Janae Hammond
LICENSING EVALUATOR NAME:Ernand Dabuet
LICENSING EVALUATOR SIGNATURE:
DATE: 10/16/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/16/2024


LIC809 (FAS) - (06/04)
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