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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198320128
Report Date: 12/05/2023
Date Signed: 12/05/2023 02:20:52 PM

Document Has Been Signed on 12/05/2023 02:20 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, 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: 3DATE:
12/05/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:39 PM
MET WITH:Charles Flemings, AdministratorTIME COMPLETED:
03:30 PM
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On 12/05/22, Licensing Program Analyst (LPA) Felisa Shirley conducted an unannounced annual required visit with a primary focus on Infection Control measures. LPA Felisa met with the Administrator Charles Flemings. LPA explained the purpose of today’s visit. The facility is licensed to operate for (4) ambulatory adults ages 18 through 59. Currently, three residents reside at this facility.

LPA Shirley and Administrator Charles Flemings toured the physical plant. It consists of the following: three (3) bedrooms and three bathrooms, living area, dining area, kitchen, and outside patio area. 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 within Title 22 regulations and were clean and operational. The water temperature measured at 115.4 F. There are no bodies of water or firearms on the premises.

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, cleaning agents, toxins, and sharps were inaccessible to clients. The kitchen was inspected and there is enough perishable and non-perishable food available which is stored properly. The fire extinguisher was checked, smoke detectors and carbon Monoxide were operable. LPA checked first aid kit; and found that it was compliant with a manual.

All mandated inspection control posters were posted.

No deficiencies cited during this visit.

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

SUPERVISORS NAME: Stephanie Cifuentes
LICENSING EVALUATOR NAME: Felisa Shirley
LICENSING EVALUATOR SIGNATURE: DATE: 12/05/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/05/2023
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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