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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198320023
Report Date: 06/06/2023
Date Signed: 07/27/2023 03:43:03 PM


COMPREHENSIVE INSPECTION

Document Has Been Signed on 07/27/2023 03:43 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 LLCFACILITY NUMBER:
198320023
ADMINISTRATOR:SUDECK, ELIZABETHFACILITY TYPE:
735
ADDRESS:11725 S TARRON AVETELEPHONE:
(310) 980-0673
CITY:HAWTHORNESTATE: CAZIP CODE:
90250
CAPACITY: 4CENSUS: 4DATE:
06/06/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:45 AM
MET WITH:House manager Maria E. ColinTIME COMPLETED:
02:15 PM
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On 06/06/23, Licensing Program Analyst (LPA) Lizeth Villegas conducted an unannounced annual required visit using the CARE Inspection Tool. LPA met with house manager Maria E. Colin and the purpose of today’s visit was explained. The facility is licensed to serve six (6) ambulatory adults ages 18-59 with developmental disabilities. Residents are linked with the Westside regional enter.

The facility is a single-story home in a residential neighborhood. The facility consists of 3 client bedrooms, 2 bathrooms, living room, dining room, kitchen, staff working area, outdoor patio with a shaded area, and a detached garage that serves as an additional pantry, stores PPE and houses an additional refrigerator.

LPA conducted a records review of two (2) staff records, two(2) resident records and two(2) Medication Administration Records. LPA did not observe any discrepancies at the time of visit. Medications were centrally stored and properly locked, first aid kit was checked and fully stocked. The last fire drill was conducted on 04/20/23, (1) fire extinguishers fully charged, carbon monoxide detectors observed and Smoke detectors are working properly. Landline observed throughout the facility.

All resident rooms were checked, mattresses and box springs were in good condition, adequate lighting, plenty of dresser and closet space was observed. Bathrooms were found to be within Title 22 regulation, toilets and water faucets worked properly, shower was free of mold/mildew, All grab bars were securely attached, all showers had a non-skid mat and there is sufficient toiletries accessible to residents. The water temperature properly measured between 105-120F.

Perishable and non-perishable food supply was checked and adequately stocked at time of visit. Toxins and knifes were observed to be locked and inaccessible to residents. Exits/ Walkways around the facility were free of debris and hazards.

SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Lizeth Villegas
LICENSING EVALUATOR SIGNATURE: DATE: 06/06/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/07/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 2
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: 06/06/2023
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During today’s visit no discrepancies were observed

Exit interview conducted with House manager Maria Colin and a copy of this report was provided.

SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Lizeth Villegas
LICENSING EVALUATOR SIGNATURE:

DATE: 06/07/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/07/2023
LIC809 (FAS) - (06/04)
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