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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198320159
Report Date: 03/14/2024
Date Signed: 04/12/2024 03:01:25 PM


Document Has Been Signed on 04/12/2024 03:01 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 ASC, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245



FACILITY NAME:PEAK PERFORMANCE SPECIALIZED FACILITY 2, INCFACILITY NUMBER:
198320159
ADMINISTRATOR:REED, VANESSAFACILITY TYPE:
735
ADDRESS:7029 ARLINGTON AVENUETELEPHONE:
(323) 933-6838
CITY:LOS ANGELESSTATE: CAZIP CODE:
90043
CAPACITY:4CENSUS: 4DATE:
03/14/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Vanessa Reed, DirectorTIME COMPLETED:
03:45 PM
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On 03/14/24, A Licensing Program Analyst (LPA) Felisa Shirley conducted an unannounced annual required visit using the CARE Inspection Tool. LPA met with the administrator Vanessa Reed. LPA explained the purpose of today’s visit. The facility is licensed to serve (4) adults ages 18 through 59, of which 4 may be non-ambulatory. Currently, the home has (4) clients.

The facility is a single-story structure located in a residential neighborhood. This facility consists of (4) bedrooms, (1.5) bathrooms, living room, kitchen and dining area, shaded in the back yard with patio, a front yard and a garage that houses the washer and dryer.

LPA Shirley and Vanessa walked through the kitchen and all appliances were in good working order. Knives were locked and stored in the kitchen and inaccessible to residents. LPA observed a 3-day supply of perishable and a 7-day supply of nonperishable foods. The water temperature measured 117.9 degrees Fahrenheit.


All bathrooms were checked, sufficient liquid soap and paper towels were observed. Toilets and water faucets worked properly.

LPA Shirley and Vanessa walked through all common areas. In the living room, kitchen, dining room there is ample seating and space for all residents. All rooms and walkways were clean, and clear of obstructions and hazards. All areas have ample lighting. All rooms, hallway, and living room have working smoke detectors. There is a charged fire extinguisher in kitchen and the rear of the house.

Con'd 809-C

SUPERVISOR'S NAME: Stephanie CifuentesTELEPHONE: (661) 644-7743
LICENSING EVALUATOR NAME: Felisa ShirleyTELEPHONE: 323-981-1755
LICENSING EVALUATOR SIGNATURE:
DATE: 03/14/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/14/2024
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 ASC, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245
FACILITY NAME: PEAK PERFORMANCE SPECIALIZED FACILITY 2, INC
FACILITY NUMBER: 198320159
VISIT DATE: 03/14/2024
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LPA Shirley and Vanessa toured the entire facility inside and out. Documents are posted as mandated. Bedrooms 1-4 are occupied by residents and contain the mandated furniture. The (1.5) bathrooms have grab bars and are clean and operational. First aid kit is fully stocked with manual. No firearms are stored at facility and no bodies of water present. Medications are stored, locked and inaccessible to residents. (1) Resident file along with medications are current. (1) Staff files are current. The facility is in good repair. Annual fees were paid 3/12/24.

PPE's will last for 30 days plus.

According to the California Code of Regulations (Title 22, Division 6, Chapter 8), LPA did not observe any deficiencies, therefore no citations were issued at this time.

An exit interview conducted with Vanessa Reed, Administrator and a hard copy of report provided.

SUPERVISOR'S NAME: Stephanie CifuentesTELEPHONE: (661) 644-7743
LICENSING EVALUATOR NAME: Felisa ShirleyTELEPHONE: 323-981-1755
LICENSING EVALUATOR SIGNATURE:

DATE: 03/14/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/14/2024
LIC809 (FAS) - (06/04)
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