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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198203257
Report Date: 05/10/2023
Date Signed: 05/10/2023 04:55:40 PM

Document Has Been Signed on 05/10/2023 04:55 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:CHALLENGE 2FACILITY NUMBER:
198203257
ADMINISTRATOR:GILBERT TEELFACILITY TYPE:
735
ADDRESS:2504 W. 164TH STREETTELEPHONE:
(310) 324-6465
CITY:TORRANCESTATE: CAZIP CODE:
90504
CAPACITY: 4CENSUS: 4DATE:
05/10/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
02:28 PM
MET WITH:JUANITA RICKERTIME COMPLETED:
05:15 PM
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 On 05/10/23 Licensing Program Analyst (LPA) Antonine Richard conducted an unannounced Annual required visit using the new Care Inspection Tool. ( LPA) met with Juanita Ricker assistant administrator, the purpose of today’s visit was explained.

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: 3 bedrooms, 3 bathrooms, family room/office, living room, kitchen, dining room, shaded area, indoor and outdoor activity area, laundry room and detached garage.

LPA and Juanita Ricker toured the entire facility inside and out. Documents are posted as mandated by the DPH and CCLD. Bedrooms 1 –3 are occupied by clients and contain the mandated furniture. The (3) 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. 3 staff files are current, 4 residents files are current along with medications. The hot water temperature measured 107.1F degrees. A comfortable temperature is maintained throughout the facility. Ample supply of perishable and nonperishable food, linens and personal hygiene supplies are adequate, hazardous toxins and/or items are inaccessible to clients, 4 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.

SUPERVISORS NAME: Ulysses Coronel
LICENSING EVALUATOR NAME: Antonine Richard
LICENSING EVALUATOR SIGNATURE: DATE: 05/10/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/10/2023
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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