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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198320140
Report Date: 04/27/2023
Date Signed: 04/27/2023 10:13:34 AM

Document Has Been Signed on 04/27/2023 10:13 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, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754
FACILITY NAME:FLORIAN HOUSE ADULT RESIDENTIAL FACILITYFACILITY NUMBER:
198320140
ADMINISTRATOR:MBANALU, EJIKEFACILITY TYPE:
735
ADDRESS:17602 CRABAPPLE WAYTELEPHONE:
(661) 313-9388
CITY:CARSONSTATE: CAZIP CODE:
90746
CAPACITY: 4CENSUS: 0DATE:
04/27/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Ejike MbanaluTIME COMPLETED:
10:30 AM
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On 04/27/23, Licensing Program Analyst (LPA) Perry Scott conducted an unannounced annual required visit using the new CARE Inspection Tool. LPA met with administrator, Ejike Mbamalu, and explained the purpose of today’s visit. This facility is licensed to serve (4) ambulatory Developmentally Disabled Adults aged 18 – 59. Currently, the home has (0) clients living in the facility. The facilities fees are current.

The facility is a two-story home located in a residential neighborhood. The property consists of the following: 4 client bedrooms, 3 bathrooms, living room, kitchen, and dining room; and an attached garage. The 2nd floor has a den, office area, and laundry room. The facility currently does not have any clients; therefore, a records review could not be completed. The facility disaster plan was current and in compliance with Title 22 at the time of visit.

At 9:00 am, LPA and Mr. Mbamalu toured the physical plant. There were no bodies of water or obstructions on the premises. All rooms were inspected. Beds and bedding supplies were in good condition, adequate lighting provided, storage for residents’ personal belongings were observed. Bed linens, comforters, and bath towels were adequately stocked at the time of visit. Toilets and water faucets worked properly. Shower was free of mold/mildew; bathrooms were found to be within Title 22 regulations and were clean and operational. The hot water temperature measured 115.6 degrees Fahrenheit.

Report continued on LIC809-C

SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Perry Scott
LICENSING EVALUATOR SIGNATURE: DATE: 04/27/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/27/2023
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754
FACILITY NAME: FLORIAN HOUSE ADULT RESIDENTIAL FACILITY
FACILITY NUMBER: 198320140
VISIT DATE: 04/27/2023
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LPA observed the facility to be sanitary and appropriately furnished at the time of visit. Storage areas for cleaning supplies, toxins, and sharps were stored and not accessible to residents. The kitchen was inspected and there is sufficient perishable and non-perishable food available and maintained properly. Fire extinguishers were charged, smoke detectors and carbon monoxide were operable. The facility has a place for medications that will be centrally stored and properly locked, first aid kit was checked and fully stocked. Exits/ Walkways around the home were free of debris and hazards.

During the visit, LPA observed the facility infection control practices. LPA observed screening protocols for visitors and sanitizing stations (Located in common areas and restrooms). LPA also observed that the facility has a 30-day supply of Personal Protective Equipment (PPE).

LPA advised the administrator to continuously monitor the Centers for Disease Control (CDC) website and Community Care Licensing (www.cdss.ca.gov) for Provider Informational Notices (PINS) for any updates relating to COVID-19 guidance and other related items.

No deficiencies were cited during this inspection visit.

An exit interview was conducted, and a copy of this report was provided to Administrator Ejike Mbamalu

SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Perry Scott
LICENSING EVALUATOR SIGNATURE:

DATE: 04/27/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/27/2023
LIC809 (FAS) - (06/04)
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