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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198320223
Report Date: 09/19/2024
Date Signed: 09/19/2024 02:23:11 PM

Document Has Been Signed on 09/19/2024 02:23 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:EMILY'S HOMECAREFACILITY NUMBER:
198320223
ADMINISTRATOR/
DIRECTOR:		FIGUEROA, PATRICKFACILITY TYPE:
735
ADDRESS:603 W. 235TH STTELEPHONE:
(310) 938-6193
CITY:CARSONSTATE: CAZIP CODE:
90745
CAPACITY: 4CENSUS: 4DATE:
09/19/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
02:14 PM
MET WITH:Noel & Novyna FigueroaTIME VISIT/
INSPECTION COMPLETED:
02:35 PM
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On 09/19/24, Licensing Program Analyst (LPA) Ernand Dabuet conducted an unannounced Case Management visit at this facility. LPA was greeted by Administrator Novyna Figueroa and explained the purpose of the visit to conduct a health and safety check. LPA explained the inspection visit is in association with an incident on 08/25/24.

An Incident reported concerning client #1 (C1) and other clients at this facility. The incident was in reference to (C1's) citizenship or/nationally.

The Department interviewed Administrator and was informed that (C1) is client of Harbor Regional Center. All of the personal information on (C1) was screened by Harbor Regional Center.

During today's inspection visit, LPA Dabuet audited service record for clients #1 (C1). LPA obtained copies or (C1's) Individual Person-Centered Plan (dated: 01/20/23), Client Development and Evaluation Report (dated: 02/01/23), Harbor Regional Center Nursing Assessment (dated: 11/19/10), Harbor Regional Center (dated: 10/01/83), Behavior Goals Progress Report (dated: 07/05/24), and Harbor Regional Center Living Options (dated: 04/28/22).

A tour of the facility and observation of clients. (C1) appeared to be presentable in appearance, was healthy, alert and well nourished.

An exit interview was conducted with Novyna Figueroa and a hard copy of the report.
SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Ernand Dabuet
LICENSING EVALUATOR SIGNATURE: DATE: 08/30/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/30/2024
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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