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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198320023
Report Date: 11/30/2023
Date Signed: 11/30/2023 03:20:39 PM

Document Has Been Signed on 11/30/2023 03:20 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 ASC, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245
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:
11/30/2023
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
02:45 PM
MET WITH:ELIZABETH SUDECK TIME COMPLETED:
03:30 PM
NARRATIVE
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On 11/30/2023, Licensing program analyst (LPA) Lourdes Montoya conducted a case management - deficiency visit during an unrelated complaint visit. LPA met with House Managers Maria E. Collin, Maria D. Colin and Administrator Elizabeth Sudeck.

During LPA's tour of the the facility with House Manager Maria D. Colin, LPA observed client's (C1) closet double doors are derailed. LPA observed the bottom rails are loose and doors are not able to slide to open/close properly.

Deficiency cited Under California Code of Regulations Title 22, Division 6 (see LIC 809D).

An exit interview was conducted, appeal rights discussed and a copy of this report and appeals were provided to Administrator Elizabeth Sudeck.
SUPERVISORS NAME: Stephanie Cifuentes
LICENSING EVALUATOR NAME: Lourdes Montoya
LICENSING EVALUATOR SIGNATURE: DATE: 11/30/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/30/2023
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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Document Has Been Signed on 11/30/2023 03:20 PM - It Cannot Be Edited


Created By: Lourdes Montoya On 11/30/2023 at 02:57 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245

FACILITY NAME: FRIENDS UNITED LLC
FACILITY NUMBER: 198320023

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/30/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
12/11/2023
Section Cited
CCR
80087(a)

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80087 Buildings and Grounds
(a) The facility shall be clean, safe, sanitary and in good repair at all times for the safety and well-being of clients, employees and visitors.
This requirement was not met as evidenced by:
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Administrator shall fix or replace the closet doors in C1's bedroom. POC shall be submitted to CCLD via email to lourdes.montoya@dss.ca.gov by the POC due date, 12/11/2023.
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LPA observed one client's (C1) closet double doors are derailed. LPA observed the bottom rails are loose and doors are not able to slide open/close properly. This poses a potential health, safety and/or personal rights risk to clients in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Stephanie Cifuentes
LICENSING EVALUATOR NAME:Lourdes Montoya
LICENSING EVALUATOR SIGNATURE:
DATE: 11/30/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/30/2023


LIC809 (FAS) - (06/04)
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