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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198320247
Report Date: 10/27/2023
Date Signed: 10/27/2023 11:52:46 AM

Document Has Been Signed on 10/27/2023 11:52 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, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754
FACILITY NAME:PERSON CENTERED OPTIONS, LLCFACILITY NUMBER:
198320247
ADMINISTRATOR:THOMPSON, TIKIFACILITY TYPE:
735
ADDRESS:1762 W. 244TH STREETTELEPHONE:
(909) 904-2913
CITY:TORRANCESTATE: CAZIP CODE:
90501
CAPACITY: 4CENSUS: 2DATE:
10/27/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
07:56 AM
MET WITH:Thompson TikiTIME COMPLETED:
12:15 PM
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On 10/27/2023, Licensing Program Analyst (LPA) Antonine Richard conducted an announced annual required visit using the new Care Inspection Tool. LPA meet with licensee Tiki Thompson and explained the purpose of today’s inspection visit. The facility is license for four (4) of which three (3) are non-ambulatory clients between the ages of 18-59. Currently, the facility home has three (3) clients.

The facility is a one-story house located in a residential neighborhood and consists of four (4) bedrooms, two (2) bathrooms, two (2) car garage, living room, family room, dining area, and kitchen. LPA and Licensee toured the physical plant. The facility is clean, sanitary, and in good repair. Protective devices are in place to include non-slip material on rugs. All window screens are clean and in good repair. The facility temperature is between 68 degrees and 85 degrees. LPA observed non-hazard tank-less water heater and a cooling/heating tank on the west side of the premises.

The facility has three (3) bedrooms for non-ambulatory clients and one (1) bedroom for an ambulatory client. All rooms include (1) a bed, one (1) chair, one (1) nightstand, and one (1) table lamp. Client bedrooms are large enough to allow for easy passage and to accommodate furniture and assertive devices such as wheelchairs, walkers, or oxygen equipment. No client bedroom is a passageway to another room, bath, or toilet. There are no staff bedrooms.

The home has two (2) bathrooms. All resident bathrooms have a working toilet, washbasin, and shower with grab bars and non-skid mats. A first aid kit is stored in a locked cabinet which has at least the following: thermometer, tweezers, scissors, antiseptic, bandages, gauze, and current first aid manual locked and inaccessible to clients. The client's medications will be stored in a locked cabinet in the laundry/kitchen area.

SUPERVISORS NAME: Ulysses Coronel
LICENSING EVALUATOR NAME: Antonine Richard
LICENSING EVALUATOR SIGNATURE: DATE: 10/27/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/27/2023
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 ASC, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754
FACILITY NAME: PERSON CENTERED OPTIONS, LLC
FACILITY NUMBER: 198320247
VISIT DATE: 10/27/2023
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LPA observed the facility to be sanitary appropriately furnished at the time of visit. Cleaning supplies, toxins, and sharps objects were stored and not accessible to clients. The kitchen was inspected and there is sufficient perishable and non-perishable food available. Five smoke detectors were observed to be hardwired and interconnected, Facility has two (2) fire extinguishers, fully charged. There are no pets, jacuzzi, or pool in the premise. The hot water temperature tested at 115. 5F degrees. Bathrooms were found to be within Title 22 regulation. the last fire drill was on 08/14/2023. All mandated inspection control posters were posted and available.

No deficiencies were cited during this inspection visit.

An exit interview held and a copy of the report was provided to the licensee Tiki Thompson.
SUPERVISORS NAME: Ulysses Coronel
LICENSING EVALUATOR NAME: Antonine Richard
LICENSING EVALUATOR SIGNATURE:

DATE: 10/27/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/27/2023
LIC809 (FAS) - (06/04)
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