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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198320128
Report Date: 12/20/2021
Date Signed: 12/20/2021 01:59:01 PM

Document Has Been Signed on 12/20/2021 01:59 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:BROOKS PLACEFACILITY NUMBER:
198320128
ADMINISTRATOR:FLEMINGS, CHARLESFACILITY TYPE:
735
ADDRESS:1117 WEST 164TH STREETTELEPHONE:
(310) 351-0221
CITY:GARDENASTATE: CAZIP CODE:
90247
CAPACITY: 4CENSUS: 2DATE:
12/20/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:45 AM
MET WITH:Flemings, CharlesTIME COMPLETED:
02:59 PM
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On 12/20/2021, Licensing Program Analyst (LPA) Ngozi Nwaokoro conducted an unannounced visit to Brooks Place. The purpose of today’s visit was to conduct the annual inspection, with emphasis on Infection Control. LPA met with the Licensee, Charles Flemings and explained the reason for the visit. Facility is licensed for 4 ambulatory residents. The facility currently has 2 ambulatory residents. None of the residents are receiving home health or hospice services.

LPA Ngozi and Charles Flemings toured the physical plant, checked food service, reviewed resident files and records status. The facility conducted a fire drill on 12/08/2021. The Facility is a one story house, 2 client bedroom, living room, dining room, and kitchen. Resident bedrooms had the required furniture, bed linens and closet/drawer space to accommodate each resident comfortably. Resident bathrooms were checked. Toilets and water faucets were checked, grab bars were secure, shower was free of mold/mildew and a non-skid mat was in place, water temperature measured at 119. degrees. Resident bath towels, toiletries and personal hygiene supplies were adequately stocked in their closet.



Kitchen was checked and observed to be within Title 22 regulations. Perishable and non-perishable food supply was checked. Cleaning solutions and hazardous items were placed in cabinets. Smoke detectors were working properly. Outside grounds were toured and no bodies of water were observed. Walkways around the home were clear of hazards. There are no security bars or weapons on the premises.

No deficiencies cited during this visit.

Exit interview conducted and a copy of this report was given to Charles Flemings.

SUPERVISORS NAME: Michael Cava
LICENSING EVALUATOR NAME: Ngozi Nwaokoro
LICENSING EVALUATOR SIGNATURE: DATE: 12/20/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/20/2021
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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