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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198204052
Report Date: 10/26/2021
Date Signed: 11/08/2021 09:00:01 AM

Document Has Been Signed on 11/08/2021 09:00 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
CCLD Regional Office, 300 N. CONTINENTAL BLVD. #290B
EL SEGUNDO, CA 90245
FACILITY NAME:FREEDOM HOUSEFACILITY NUMBER:
198204052
ADMINISTRATOR:SCHEY, PETERFACILITY TYPE:
730
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 12CENSUS: 1DATE:
10/26/2021
TYPE OF VISIT:Annual/RequiredUNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Lydia Quintanilla-Interim AdministratorTIME COMPLETED:
03:00 PM
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On October 26, 2021 at 10:00am Licensing Program Analyst (LPA) Donald Martin arrived at the Freedom House for the purpose of conducting an Annual/Required inspection. LPA was met by Lydia Quintanilla and allowed to enter the facility. The inspection is as follows:

Front door entry leads into the living room where the clients personal rights, facility profile and grievance policy and forms are posted for clients to see. There are two rooms off the living room. One contains several computers for the clients use and the other is a game room with a pool table and a small weight room for clients use.
The kitchen has a large stove with a hood that has a sprinkler system. Clients use the stove for independent skill building but for the most part staff cooks for the clients. The refrigerator was clean and has a two day supply of food. The pantry has plenty of food and can goods. There is a weeks worth of non perishable foods as well. The facility receives food through InstaCart and Homies Unidos. There is a room with a Subzero freezer and an additional refrigerator for food storage. There is a locked closet that contains tool and cleaning supplies that is inaccessible to clients. There is another room that has lockers for the clients to store personal items.
There is a bedroom downstairs used for overnight staff use only. There are two bathrooms downstairs as well. Upstairs.
There are 8 bedrooms upstairs only 1 is in use at the time of the visit. The rooms are very big and spacious. The client had plenty of clothing and storage room for him to store them away. There is a room used for storage that stays locked that contains hygiene products and stationary, backpacks and other donated school supplies for the clients. Linen is kept in the staff room downstairs. There is a fire alarm pull station and an unlocked exit door on either end of the hall. There are 3 bathrooms upstairs and 3 showers for the clients.

Cont on 809-C
SUPERVISORS NAME: JoAunne Griffin
LICENSING EVALUATOR NAME: Donald C Martin
LICENSING EVALUATOR SIGNATURE: DATE: 10/26/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/26/2021
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
CCLD Regional Office, 300 N. CONTINENTAL BLVD. #290B
EL SEGUNDO, CA 90245
FACILITY NAME: FREEDOM HOUSE
FACILITY NUMBER: 198204052
VISIT DATE: 10/26/2021
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There is an attic door that leads to a room that is empty. This door remains locked and inaccessible to clients. There is also a fire extinguisher in the hallway.
The basement was very spacious and clean. The wall are decorated with art from people in the community and from some of the clients. The washer and dryer is located in the basement and can be used by the clients when supervised by staff. Knives are kept in a locked drawer in the office. The water temperature is 120 and within the state guidelines. There is a structure on the side of the house that is used for storage and inaccessible to clients. The outside has a large garden area surrounding the home. The structure is in fair shape as well as the garden. Note: There are 6 working camera angles noted by LPA on the premises. One in the hallway upstairs, one facing the door on the inside at the entrance, and four attached to the outside of the building that show the property only. Smoke detectors were noticed hard wired into the home but out of LPA's reach. The overall home inside and out was very clean and in order.

Note: LPA discussed the cameras that are located at the facility. It was discussed that the cameras located inside of the facility need to be removed due to no camera waivers being permitted by CCL at this time. LPA also requested Lydia Quintanilla submit a letter regarding the outside cameras to my attention as soon as possible.

There is one staff currently on duty at the facility; "S1". She is fingerprint cleared and associated to the facility. LPA will return to do staff and client file review and interviews.

There are no deficiencies to report at the time of this visit. A copy of this report will be left with Administrator, Lydia Quintanilla.
SUPERVISORS NAME: JoAunne Griffin
LICENSING EVALUATOR NAME: Donald C Martin
LICENSING EVALUATOR SIGNATURE:

DATE: 10/26/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/26/2021
LIC809 (FAS) - (06/04)
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