198203257-6-14-2023-11-AS-ARID-CSSKTG-20230614081104

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 198203257
Report Date: 05/10/2023
Date Signed: 06/14/2023 08:11:10 AM

COMPREHENSIVE INSPECTION

Document Has Been Signed on 06/14/2023 08:11 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, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754

FACILITY NAME:	CHALLENGE 2		FACILITY NUMBER:	198203257
ADMINISTRATOR:	GILBERT TEEL		FACILITY TYPE:	735
ADDRESS:	2504 W. 164TH STREET		TELEPHONE:	(310) 324-6465
CITY:	TORRANCE	STATE: CA	ZIP CODE:	90504
CAPACITY: 4		CENSUS: 4	DATE:	05/10/2023
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	02:28 PM
MET WITH:	JUANITA RICKER		TIME COMPLETED:	05:15 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	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 purposed of today's today visit was explained. There a 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, shade area, indoor and outdoor activity area, laundry room and a detached garage. LPA and Juanita Ricker toured the entire facility inside and out. Document are posted as mandate by the DPH and CCLD. Bedrooms 1-3 are occupied by clients and contain the mandate furniture. The (3) bathroom are clean and operational. Smoke detectors and carbon monoxide detector are in compliance and operational. No firearms are stored at the 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: 05/12/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/12/2023

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: CHALLENGE 2	FACILITY NUMBER: 198203257
	VISIT DATE: 05/10/2023

NARRATIVE

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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. LPA observed staff and clients wearing masks, clients can isolate in their room if necessary required postings throughout the facility. LPA observed that sanitizer is administered to clients based on the level of functioning with the supervision of staff. The facility has an approved Mitigation plan. 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 observed any deficiencies, therefore no citations were issued at this time.

An exit interview was conducted and a copy of this report was provided to administrator assistant Juanti Ricker.

SUPERVISORS NAME: Ulysses Coronel
LICENSING EVALUATOR NAME: Antonine Richard
LICENSING EVALUATOR SIGNATURE:	DATE: 05/12/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/12/2023

LIC809 (FAS) - (06/04)

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