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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198320044
Report Date: 08/23/2022
Date Signed: 08/23/2022 04:46:30 PM


Document Has Been Signed on 08/23/2022 04:46 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
CCLD Regional Office, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754



FACILITY NAME:ALTERNATIVE RESIDENTIAL CAREFACILITY NUMBER:
198320044
ADMINISTRATOR:MCNAMARA, MINDYFACILITY TYPE:
740
ADDRESS:2653 W 225TH STREETTELEPHONE:
(310) 325-1735
CITY:TORRANCESTATE: CAZIP CODE:
90505
CAPACITY:6CENSUS: 6DATE:
08/23/2022
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
02:33 PM
MET WITH:Minda Mc Namara LicenseeTIME COMPLETED:
04:49 PM
NARRATIVE
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On 8/25/2022 LPA conducted a case management visit at the facility. LP arrived at the facility at 10:30 AM and was greeted by Minda McNamara Licensee. The purpose of the visit was discussed with the administrator.
During the visit LPA entered area next to the kitchen and observed staff working in the area. LPA requested the names of the staff working at the time of the visit. Licensee provide a list to LPA. LPA reviewed the list and observed a staff member working that was not on the list. LPA questioned Licensee who provided a statement “I must have forgotten to turn in the paper work I thought my staff was going to do it”. Based on LPA's observation and interviews California Code of Regulations title 22 division and chapter number are being cited on the attached LIC 809 D

Civil Penalty Assessed on today's date $500.00.



Exit interview held. A copy of the report and appeal rights were provided.
SUPERVISOR'S NAME: Janae HammondTELEPHONE: (323) 395-3554
LICENSING EVALUATOR NAME: Jeremiah RandleTELEPHONE: (323) 981-1755
LICENSING EVALUATOR SIGNATURE:
DATE: 08/23/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/23/2022
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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Document Has Been Signed on 08/23/2022 04:46 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754


FACILITY NAME: ALTERNATIVE RESIDENTIAL CARE
FACILITY NUMBER: 198320044

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/23/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
08/23/2022
Section Cited

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Criminal Record Clearance: (e) All individuals
subject to a criminal record review pursuant to
Health and Safety Code Section 1569.17(b)
shall prior to working, residing or volunteering
in a licensed facility: (1) Obtain a California
clearance or a criminal record exemption as
required by the Department...This requirement
was not met as evidenced by:
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Licensee did not comply with this regulation as
S1 was working at the facility from May 10 2022
to presentCivi without a criminal background
clearance or fingerprint clearance. This posed
an immediate health and safety risk to all
residents 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: Janae HammondTELEPHONE: (323) 395-3554
LICENSING EVALUATOR NAME: Jeremiah RandleTELEPHONE: (323) 981-1755
LICENSING EVALUATOR SIGNATURE:
DATE: 08/23/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/23/2022
LIC809 (FAS) - (06/04)
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