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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198320231
Report Date: 03/21/2024
Date Signed: 03/21/2024 11:50:04 AM

Document Has Been Signed on 03/21/2024 11:50 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 ASC, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245
FACILITY NAME:REM CALIFORNIA, LLC - ATHERTONFACILITY NUMBER:
198320231
ADMINISTRATOR:DIAZ, JESSICAFACILITY TYPE:
735
ADDRESS:6927 ATHERTON STREETTELEPHONE:
(562) 343-7211
CITY:LONG BEACHSTATE: CAZIP CODE:
90815
CAPACITY: 3CENSUS: 3DATE:
03/21/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:28 AM
MET WITH:Jessica Diaz-AdministratorTIME COMPLETED:
11:47 AM
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On 3/21/24 Licensing Program Analysts (LPAS) Darneisha Cross and Alfonso Iniguez conducted an unannounced annual required visit using the CARE Inspection Tool. LPAs met with Jessica Diaz/Administrator and the purpose of today’s visit was explained. The facility is licensed to operate for (3) ambulatory developmentally disabled or Mentally Ill adults ages 18 through 59. Currently, the home has (3) clients. The clients are from: Harbor Regional Center. None of the clients have Restricted Health Care Conditions, and none utilizes postural support or protective devices.

The facility is a one-story family home in a residential neighborhood. 3 bedrooms and 2 bathrooms There is a family room, living room, attached garage, laundry room, 2 common bathrooms, (both of which are wheelchair accessible), kitchen, and backyard.

LPA Iniguez and cross with administrator toured the inside and outside of the facility. All client rooms were checked. Mattresses and box springs were in good condition, adequate lighting was observed, plenty of dresser and closet space was observed. Bed linens, comforters and bath towels were adequately stocked at the time of visit. Bathrooms were found to be within Title 22 regulation. Toilets and water faucets worked properly. The shower was free of mold/mildew, there is adequate lighting, and sufficient toiletries accessible to clients. The water temperature properly measured between 105F°-120F° degrees (Kitchen 118.8F°, Bathroom #1 116.8°F).

Evaluation Report continues LIC 809-C

SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Alfonso Iniguez
LICENSING EVALUATOR SIGNATURE: DATE: 03/21/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/21/2024
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: REM CALIFORNIA, LLC - ATHERTON
FACILITY NUMBER: 198320231
VISIT DATE: 03/21/2024
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LPA Iniguez and Cross observed the facility clean, sanitary, and appropriately furnished at the time of the visit. Perishable and non-perishable food supplies were checked and adequately stocked at the time of the visit. Carbon monoxide/Smoke detectors were observed and operational. Fire extinguishers were fully charged, toxins and knives were locked and inaccessible to clients. Medications were centrally stored and properly locked, first aid kit was checked and fully stocked. The last facility disaster drill was:2/14/24. LPA reviewed the facility disaster plan. The facility disaster plan was current and in compliance with Title 22 at the time of visit. A total of (3) clients records and (3) staff records and (3) Medication Administration Records (MARS) LPAs found no discrepancies at the time of the visit.

Facility licensee fees are current. Copy of surety bond was provided during this visit.

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


An exit interview was conducted, and a copy of the Facility Evaluation Report was provided to Jessica Diaz /Administrator.

SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Alfonso Iniguez
LICENSING EVALUATOR SIGNATURE:

DATE: 03/21/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/21/2024
LIC809 (FAS) - (06/04)
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