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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198320310
Report Date: 09/06/2023
Date Signed: 09/06/2023 03:56:34 PM

Document Has Been Signed on 09/06/2023 03:56 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:LONE STAR LONG BEACH ADULT RESIDENTIAL FACILITYFACILITY NUMBER:
198320310
ADMINISTRATOR:STINSON, RAHMIDFACILITY TYPE:
735
ADDRESS:6165 LINDEN AVETELEPHONE:
(818) 470-9185
CITY:LONG BEACHSTATE: CAZIP CODE:
90805
CAPACITY: 6CENSUS: 0DATE:
09/06/2023
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
12:03 PM
MET WITH:Administrator Rahmid StinsonTIME COMPLETED:
03:00 PM
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On 09/06/2023 Licensing Program Analyst (LPA) Lizeth Villegas, conducted an announced visit to the facility for purpose of a Prelicensing evaluation and met with Administrator Rahmid Stinson.

An application was submitted to CCLD on 05/22/2022 and was updated on 03/22/23, for Initial license for an Adult Residential Facility to serve six (6) ambulatory adults ages 18 to 59.

Facility is a single-story house in a residential neighborhood that consist of the following: (3) bedroom, (2) bathroom, (1) staff office, living room/dinning room area, kitchen, laundry area, a detached garage/storage unit and a backyard shaded patio area. The client bedrooms are spacious and will easily accommodate the client's furnishings. All passageways, walkways, driveways, steps, and patios are free from obstructions. The residence is equipped with central air and heat.

There shall be no more than two clients per bedroom. Bedrooms consist of two beds, two chairs, two night stands, two lamps in addition to overhead lighting. There are two dressers with four drawers, which comply with the requirement of 8 cubic feet of space.

All bathrooms have a working toilet, wash basin, bath-tub/shower and free of mold and mildew. Beds have the required linen/supplies which include, pillowcase, mattress pads, fitted sheet, blanket and bedspreads. Adequate supply of linen and hygiene products stored in hallway storage closet.

Posted & readily available for review in living room/dining area is the emergency disaster plan. Fire Extinguishers located in kitchen (mounted on wall), a second extinguisher is located next to laundry area (mounted on wall).

SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Lizeth Villegas
LICENSING EVALUATOR SIGNATURE: DATE: 09/06/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/06/2023
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: LONE STAR LONG BEACH ADULT RESIDENTIAL FACILITY
FACILITY NUMBER: 198320310
VISIT DATE: 09/06/2023
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Dishes, cups and flatware are stored in the kitchen cupboards, inspected and in good repair. Knives, cutlery, and other sharp kitchen utensils are stored in a locked file cabinet. Stove and refrigerator were observed to be operational; refrigerator has a measured temperature of at least 45 degrees Fahrenheit for appropriate food storage. Freezer is at (0) zero degrees Fahrenheit.

Smoke detectors and carbon monoxide detectors were observed to be interconnected and operational.

No firearms will be in the facility, Toxins and cleaning compounds will be locked and inaccessible to clients in the staff office.

Water temperatures measured between 105 F.- 120 F.

A 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 medication cabinet and available for staff use but inaccessible to clients.

Applicant will be handling cash resources of clients and has a surety bond, cash resources will be locked and stored with P & I Ledger, accessible to designated staff. Records for staff and clients shall be stored in a locked cabinet located in staff office.

The facility has board games, books, and other recreational materials for the client's use, commensurate with the plan of operation.

No bodies of water on the premises.

Fire Clearance was approved on 10/24/2022 by the Long Beach fire department. No security bars on facility windows, backyard gate has a key lock.

During today’s visit no discrepancies were observed. Component III reviewed, exit interview conducted with Administrator Rahmid Stinson, and a copy of this report was provided.

SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Lizeth Villegas
LICENSING EVALUATOR SIGNATURE:

DATE: 09/06/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/06/2023
LIC809 (FAS) - (06/04)
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