198320023-1-6-2023-11-AS-WGIS-CM6SA8-20221216124154

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 198320023
Report Date: 12/16/2022
Date Signed: 01/06/2023 04:36:15 PM

Document Has Been Signed on 01/06/2023 04:36 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:	FRIENDS UNITED LLC		FACILITY NUMBER:	198320023
ADMINISTRATOR:	SUDECK, ELIZABETH		FACILITY TYPE:	735
ADDRESS:	11725 S TARRON AVE		TELEPHONE:	(310) 980-0673
CITY:	HAWTHORNE	STATE: CA	ZIP CODE:	90250
CAPACITY: 4		CENSUS: 4	DATE:	12/16/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	09:43 AM
MET WITH:	Maria Colin		TIME COMPLETED:	12:45 PM

NARRATIVE

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Licensing Program Analyst (LPA) Wendy Gibbs conducted an unannounced required annual visit with a primary focus on Infection Control measures using the CARE Inspection Tools. Upon arrival at the facility, LPA called facility and spoke with administrator Elizabeth Sudeck to conduct a risk assessment over the telephone. Based on the assessment, the facility is clear of Covid-19 infection. The facility is licensed for 4 ambulatory clients; there are currently four (4) clients in placement. LPA met with the house manager Maria Colin and toured the inside and outside grounds of the facility.

Structure Facility has (3) bedrooms, two (2) bathrooms, it is single story house with attached garage, living room, dining room, family rooms and kitchen.

Physical Plant LPA walked the outside grounds. On the back patio there is ample seating with tables, chairs, and an umbrella. All walkways are clean, and clear of debris and obstructions. No bodies of water were observed.

Bedrooms LPA walked through all bedrooms and found they contained the necessary furniture including a bed, chair, dresser, and nightstand. There was ample lighting and closet space for all residents. The beds contained the necessary linens including mattress pad, fitted sheets, blanket comforter and pillow.

Bathrooms Both bathrooms were checked and found to have sufficient liquid soap and paper towels were observed. Showers, toilets, and water faucets worked properly. The showers had nonskid mats and safety bars securely fastened. The water measured between 110.3 and 111.4 degrees Fahrenheit.

Linens & Hygiene LPA observed additional sheets and comforter in residents closets. In the hall closet there are additional linens stored including towels, sheet, blankets and comforters. In a locked closet in the hallway is additional hygiene products.

SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Wendy Gibbs
LICENSING EVALUATOR SIGNATURE:	DATE: 12/16/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/16/2022

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: FRIENDS UNITED LLC	FACILITY NUMBER: 198320023
	VISIT DATE: 12/16/2022

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Kitchen LPA observed the kitchen to be clean and well maintained. All appliances were in good working order. LPA observed a 3-day supply of perishable foods and a 7day supply of nonperishable foods. All cutleries were in good condition. Knives and toxins were locked in a closet in the pantry. The water temperature measured 111.2 degrees Fahrenheit.

Common Areas Common areas were clean and clear of hazards; doorways were free of obstructions. There was ample seating for all residents. LPA observed activities for residents. All areas had ample lighting. The home was kept at a comfortable temperature.

Safety All smoke detectors were in good working order. The carbon monoxide detector was in good working order. The fire extinguisher was fully charged and last serviced on 11/22/22. The last emergency drill was on 10/10/22. Emergency numbers were posted. LPA observed a working landline. LPA inspected the First Aid Kit and found it contained all the required item and a manual. There were PPEs at the entrance sanitizing station and additional supply in the locked closet in the hallway and in the garage.

Infection Control During the tour, LPA observed the facility’s infection control practices. Upon entry LPA was screened for Covid-19 symptoms and temperature was checked. LPA observed a sanitizing station at the facility entrance; visitors log with Covid-19 screening and temperature log, and records of daily Covid-19 screening and temperature checks of residents and staff. PPE supplies are readily available to staff. Sufficient paper, cleaning, and disinfecting supplies were observed. All staff wear a face covering. LPA observed required postings throughout the facility. Covid-19 Infection Control and Prevention training records were reviewed.

Files LPA reviewed all resident files, they contained all the necessary documents. LPA reviewed 3 staff files, they contained all the necessary documents

Medication LPA reviewed centrally stored medications for all residents and matched them to the MARs. Medications were locked in the hallway closet and inaccessible to residents.

Surety bond was viewed.

No deficiencies were cited during this visit.

An exit interview was conducted, and a copy of this report provide

SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Wendy Gibbs
LICENSING EVALUATOR SIGNATURE:	DATE: 12/16/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/16/2022

LIC809 (FAS) - (06/04)

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