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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198320255
Report Date: 05/03/2024
Date Signed: 05/03/2024 01:38:11 PM

Document Has Been Signed on 05/03/2024 01:38 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, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754
FACILITY NAME:FAITHFUL ADULT RESIDENTIAL FACILITYFACILITY NUMBER:
198320255
ADMINISTRATOR/
DIRECTOR:		REDMOND, SHAFUNFACILITY TYPE:
735
ADDRESS:2073 EAST BLISS STREETTELEPHONE:
(310) 597-3152
CITY:COMPTONSTATE: CAZIP CODE:
90222
CAPACITY: 4CENSUS: 0DATE:
05/03/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:40 PM
MET WITH:James RedmondTIME VISIT/
INSPECTION COMPLETED:
02:00 PM
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On 05/03/2024 at around 12:40 PM, Licensing Program Analyst (LPA) Leandro conducted an unannounced Required – 1 Year Inspection to the above-named facility and met with James Redmond. LPA explained the purpose of the visit and was accompanied by Redmond inside and outside the facility during this inspection.

This facility is licensed to serve 4 ambulatory adults ages 18 – 59 years.

A total of 0 ambulatory clients are currently residing in this facility.
There are currently 0 employees at the facility.

There is a balance of $454 in Annual Licensing Fees due on 05/01/2024.

The facility is a one-story house located in a residential street. The home consists of 4 client bedrooms, 1 office room, 1 kitchen/dining/living room area, 2 bathrooms, 1 backyard patio area with shaded seating.

Outside grounds were toured and no bodies of water were observed. The patio furniture is under a shaded area and accessible to clients. Walkways around the home were clear of hazards. There are no weapons on the premises.
SUPERVISORS NAME: Ulysses Coronel
LICENSING EVALUATOR NAME: Socorro Leandro
LICENSING EVALUATOR SIGNATURE: DATE: 05/03/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/03/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 2
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: FAITHFUL ADULT RESIDENTIAL FACILITY
FACILITY NUMBER: 198320255
VISIT DATE: 05/03/2024
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4 out of 4 clients’ bedrooms were checked. Mattresses were in good condition, adequate lighting, plenty of dresser and closet space observed. Walls and floors were clean and in good condition. Bathroom toilets and water faucets worked properly. LPA tested hot water temperature and it measured between 105 and 120 degrees Fahrenheit.

No deficiencies cited are being cited based on LPA observation accordance with the California Code of Regulations, Title 22.

An exit interview was conducted and a copy of this report was left with Redmond.
SUPERVISORS NAME: Ulysses Coronel
LICENSING EVALUATOR NAME: Socorro Leandro
LICENSING EVALUATOR SIGNATURE:

DATE: 05/03/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/03/2024
LIC809 (FAS) - (06/04)
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