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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198320276
Report Date: 06/16/2023
Date Signed: 06/16/2023 02:02:28 PM

Document Has Been Signed on 06/16/2023 02:02 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, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754
FACILITY NAME:EMBRACE RESIDENTIAL HOMES INC.FACILITY NUMBER:
198320276
ADMINISTRATOR:WASHINGTON, CARMITA; LEWISFACILITY TYPE:
735
ADDRESS:14818 SOUTH BUTLER AVETELEPHONE:
(424) 785-8202
CITY:COMPTONSTATE: CAZIP CODE:
90221
CAPACITY: 4CENSUS: 3DATE:
06/16/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:15 AM
MET WITH:Craig LewisTIME COMPLETED:
02:00 PM
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On 06/16/2023, Licensing Program Analyst (LPA), Antonine Richard, conducted an announced Annual required visit using the Care Inspection Tool. During the visit, LPA met with Licensee Craig Lewis and the purpose of today's visit was explained. The facility is an Adult Residential Facility licensed to serve Developmentally Disabled Adults for ages 18 to 59 years. The capacity is for 4 ambulatory clients.

There are currently 3 residents in placement. The facility is a 4 bedroom, 3 bathrooms, single story house. The client bedrooms are spacious and furnished. There is a back yard with a covered patio for shade. The patio contained 1 table and 4 chairs. Outdoor passageways, walkways, driveways, steps and patios are free from hazards and obstructions. All Bedrooms are for 4 ambulatory clients. Bedroom #1, #2, #3 and #4 each have one bed, one chair, one-night stand, one lamp in addition to overhead lighting. Bathrooms 1,2 and 3 have a working toilet, wash basins and showers. LPA observed adequate lighting in hallway leading to bathrooms 2. Beds have the required linen/supplies which include, pillowcase, mattress pads, fitted sheet, blanket and bedspreads. Adequate supply of linen stored in hall closet.

The smoke detectors and Carbon Monoxide detectors located throughout the facility are fully operational. Emergency Disaster Plan and "See something, Say something Let Us Know" posted & readily available for review on the wall between the living room and kitchen. Menu available for review located in a locked kitchen cabinet opposite the refrigerator. Fire Extinguishers mounted on the kitchen wall opposite postings. Dishes, cups and flat ware are stored in the kitchen cupboards, inspected and in good repair. Knives, cutlery and other sharp kitchen utensils are stored in a locked cabinet located in the kitchen area.

LIC809-C
SUPERVISORS NAME: Ulysses Coronel
LICENSING EVALUATOR NAME: Antonine Richard
LICENSING EVALUATOR SIGNATURE: DATE: 06/16/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/16/2023
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, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754
FACILITY NAME: EMBRACE RESIDENTIAL HOMES INC.
FACILITY NUMBER: 198320276
VISIT DATE: 06/16/2023
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 The kitchen was inspected and there is enough perishable and non-perishable food available which is stored properly. A variety of Fresh and Canned fruit, vegetable and meat food items. The facility has a laundry room washer, and dryer are working. The refrigerator in the kitchen has a measured temperature of at least 47 degrees Fahrenheit for appropriate food storage. Freezer is at 0 zero degrees Fahrenheit. The residence is equipped with central air and heat and each client bedroom is individually climate controlled Locked/stored in the storage room located in the kitchen. The hot water temperature tested at 105.3F degrees. Medication administration records and first aid kit has been inspected which has at least the following: thermometer, tweezers, scissors, antiseptic, bandages, gauze and current first aid manual, which are stored in locked kitchen cabinet adjacent the refrigerator, available for staff use but inaccessible to clients. The Licensee will be handling cash resources for clients and has a surety bond for $2500.00. Cash resources is locked and stored with P & I Ledger. Facility files were reviewed. Clients and Staff files were randomly chosen for review and current.

The facility has board games, books, and other recreational materials for the client's use. Activity board is posted on the wall between the kitchen and the living room. LPA observed the facility has 30-days supply of Personal Protective Equipment (PPE). The facility liability insurance is current.

An exit interview was conducted, and a copy of this report was provided to the Licensee Craig Lewis.
SUPERVISORS NAME: Ulysses Coronel
LICENSING EVALUATOR NAME: Antonine Richard
LICENSING EVALUATOR SIGNATURE:

DATE: 06/16/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/16/2023
LIC809 (FAS) - (06/04)
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