198203323-9-23-2022-11-AS-PSCT-CJJN8M-20220923101435

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 198203323
Report Date: 09/23/2022
Date Signed: 09/23/2022 10:14:44 AM

Document Has Been Signed on 09/23/2022 10:14 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:	PRECISE CARE		FACILITY NUMBER:	198203323
ADMINISTRATOR:	CHARLOTTE HEIM		FACILITY TYPE:	735
ADDRESS:	832 WEST 103RD STREET		TELEPHONE:	(323) 756-5273
CITY:	LOS ANGELES	STATE: CA	ZIP CODE:	90044
CAPACITY: 6		CENSUS: 2	DATE:	09/23/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	09:00 AM
MET WITH:	Charlotte Heim		TIME COMPLETED:	10:45 AM

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On 09/23/22, Licensing Program Analyst (LPA) Perry Scott made and unannounced visit to Precise Care, for the required annual inspection, with a primary focus on Infection Control measures using the new CARE Inspection Tool. On today’s visit LPA met with the Director Charlotte Heim, and the purpose of the visit was explained. Upon entry, my temperature was taken, and I was presented with a visitor’s log to sign in. Ms. Heim was wearing a mask. The facilities annual fees are not current. There is an outstanding balance of $681.00 due.

The home has a capacity to serve six (6) and is approved to serve developmentally disabled adults 19 to 59 years old, ambulatory only. Currently the facility has two (2) ambulatory clients, of which none have a restricted health care condition. As part of the inspection, my primary focus was on infection control. LPA observed the facility’s infection control practices: LPA observed a sanitizing station at the facility entrance. PPE supplies are readily available to staff, and additional supplies are stored. Sufficient paper, cleaning, and disinfecting supplies were observed. The facility has the mandated COVID infection control posters.

LPA Scott and Charlotte Heim toured the entire facility inside and out. The home consists of 3 client bedrooms, 1 bathroom, living room, kitchen, and dining area. All client rooms were checked. Mattresses and box springs were in good condition, adequate lighting, plenty of dresser and closet space was observed. Walls and floors were clean and in good repair. Bed linens, comforters and bath towels were adequately stocked at the time of visit. Bathroom was found to be within Title 22 regulation. Toilets and water faucets worked properly. Shower was free of mold/mildew, adequate lighting, and sufficient toiletries accessible to clients. Water temperature measured at 111.5 degrees f. The last fire drill was conducted on 04/07/22. LPA checked staff and client files, and all were complying.

Continued on LIC 809C

SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Perry Scott
LICENSING EVALUATOR SIGNATURE:	DATE: 09/23/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/23/2022

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: PRECISE CARE	FACILITY NUMBER: 198203323
	VISIT DATE: 09/23/2022

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Perishable and non-perishable food supply was checked and adequately stocked at time of visit. Smoke/Carbon monoxide detectors were operational. Fire extinguishers were fully charged and operational, toxins and knifes were locked and inaccessible to clients. Medications were centrally stored and properly locked, first aid kit was checked an in order. Outside grounds were toured and no bodies of water were observed. Patio furniture with umbrella was accessible. Exits/ Walkways around the home were free of debris and hazards.

During the visit, LPA observed the following to be complying: the facility's infection control practices; screening protocols for visitors, staff, and residents, sanitizing stations in common areas and restrooms; all staff were wearing a face covering; the facility has a 90-day supply of Personal Protective Equipment (PPE). All mandated inspection control posters were posted. The facility has a Mitigation Plan Report approved by CCLD.

LPA advised the Administrator to continuously monitor the Centers for Disease Control (CDC) website and Community Care Licensing website (cdss.ca.gov) for Provider Informational Notices (PIN) and for any updates relating to COVID-19 guidance.

The director paid the outstanding annual fees during the visit.

No deficiencies cited: Exit Interview Conducted and a copy of the Facility Evaluation Report was given to the licensee Charlotte Heim.

SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Perry Scott
LICENSING EVALUATOR SIGNATURE:	DATE: 09/23/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/23/2022

LIC809 (FAS) - (06/04)

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