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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198320075
Report Date: 11/09/2023
Date Signed: 11/14/2023 10:28:52 AM

Document Has Been Signed on 11/14/2023 10:28 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
EL SEGUNDO ASC, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754
FACILITY NAME:ADAMS HOUSE, INC., THEFACILITY NUMBER:
198320075
ADMINISTRATOR:ADAMS, TERRENFACILITY TYPE:
735
ADDRESS:806 E.CLAUDE STREETTELEPHONE:
(310) 756-6654
CITY:CARSONSTATE: CAZIP CODE:
90746
CAPACITY: 4CENSUS: 0DATE:
11/09/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:36 AM
MET WITH:Director Terren AdamsTIME COMPLETED:
01:15 PM
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On 11/09/23, Licensing Program Analyst (LPA) Villegas conducted an unannounced annual required visit using the CARE Inspection Tool. LPA met with Director Terren Adams as the purpose of the visit was explained. The facility is licensed to serve 4 Ambulatory developmentally disabled clients (age 18-59). There are currently (0) clients in care as facility is awaiting vendorization form the South Central Regional Center.

The facility is a two-story structure located in a residential neighborhood and consists of the following: 3 bedrooms, 2 bathrooms, family room/dining room, kitchen/tv room, living room, indoor and outdoor activity area, an attached garage that houses a washer and dryer, an additional refrigerator, exercise equipment a hockey table as well as a fire extinguisher. There are no bodies of water or firearm/ammunition on the premises.

All client rooms were checked. Beds and bedding were in good condition, adequate lighting provided, storage for client personal belongings was observed. Walls and floors were in good repair. Bed linens, comforters, and bath towels were adequately stocked at the time of visit. Bathrooms were found to be operational, water temperatures measured between 105-120 F.. A comfortable temperature is maintained in the facility. LPA observed the facility to be clean and appropriately furnished at the time of visit. Storage areas for personal hygiene, toxins, and sharps were inaccessible to clients. The kitchen was inspected, and observed 7 days of non-perishable and 2 days supply of perishable food. 1 Fire extinguisher observed in the kitchen, smoke detectors and carbon monoxide were operable and a landline was observed.

During today’s visit no discrepancies were observed.

Exit interview conducted with Director Terren Adams, and a copy of this report was provided.

SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Lizeth Villegas
LICENSING EVALUATOR SIGNATURE: DATE: 11/09/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/09/2023
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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