198320314-10-6-2023-11-AS-PSCT-CWCQ4J-20231006115025

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 198320314
Report Date: 10/06/2023
Date Signed: 10/06/2023 11:50:38 AM

Document Has Been Signed on 10/06/2023 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, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754

FACILITY NAME:	WRIGHTS NON MEDICAL HOME CARE PROVIDERS SERVICES		FACILITY NUMBER:	198320314
ADMINISTRATOR:	WRIGHT, HERBERT		FACILITY TYPE:	736
ADDRESS:	16331 SOUTH TARRANT AVENUE		TELEPHONE:	(909) 693-0441
CITY:	CARSON	STATE: CA	ZIP CODE:	90746
CAPACITY: 6		CENSUS: 0	DATE:	10/06/2023
TYPE OF VISIT:	Prelicensing	ANNOUNCED	TIME BEGAN:	09:35 AM
MET WITH:	Herbert Wright		TIME COMPLETED:	12:15 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	On 10/06/23, at 09:35am, Licensing Program Analyst (LPA) Perry Scott conducted an announced visit to this home for the purpose of pre-licensing. LPA was greeted by applicant, Herbert Wright, and explained that the purpose of today’s visit was for a pre-licensing inspection visit. An application was submitted to CCLD on 06/10/22 in the initial license application for a Residential Facility-Chronically Facility, age range 18 through 59 years. The applicant requested a capacity of six (6) individuals, of which six (6) may be ambulatory, and zero (0) non-ambulatory. Structure: The home is a three (3) bedroom, two (2) bathroom, two-story home with a one (1) car garage situated in a residential neighborhood. The home includes a living, dining, kitchen, and laundry area. The living area included two couches, a table, an end table, and a television. The kitchen does not have a stove or refrigerator and cabinets are being installed. The rear exterior is fenced throughout. The passageways, walkways, and steps have hazards and obstructions that need to be cleared. Bedrooms Residents: The facility has three (3) bedrooms for residents. Bedrooms 1-3 do not have the required items per title 22 regulations. All rooms do not include a full- or twin-size bed, one (1) chair, one (1) nightstand, and one (1) table lamp. All bedrooms are not equipped with a ceiling light, the applicant plans to use table lamps which were not available at the visit. All rooms did not have a dresser, which complies with the requirement of 8 cubic feet of space. All rooms had closets for ample storage. The applicant is installing new flooring in the bedrooms. It is not complete as of this visit. Bedrooms Staff: There will not be no live-in staff. Report continued on LIC809-C

SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Perry Scott
LICENSING EVALUATOR SIGNATURE:	DATE: 10/06/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/06/2023

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 ASC, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754

FACILITY NAME: WRIGHTS NON MEDICAL HOME CARE PROVIDERS SERVICES	FACILITY NUMBER: 198320314
	VISIT DATE: 10/06/2023

NARRATIVE

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Bathrooms:
The home has two (2) bathrooms. Bathrooms are accessible on the first and second floor of the home. All bathrooms have a working toilet, washbasin, but does not contain grab bars and non-skid mats. The upstairs bathroom is under repair and needs flooring.

Linens & Hygiene Supplies:
Beds have the required linen supplies which include pillowcases, mattress pads, fitted sheets, blankets, and bedspreads. An adequate supply of linen is stored in the upstairs cabinet.

Emergency Phone Numbers, Exit Plan & Menu:
Emergency phone numbers and disaster plan are not posted. The exit plan and menu are not posted nor readily available for review throughout the home. There are two (2) fire extinguishers, the first is located in the kitchen area mounted on the wall, the other is upstairs in the hallway. A telephone line is not available in the home as of this visit. Emergency supplies and Personal Protective Equipment supplies are stored in the garage. The applicant submitted a Mitigation Plan on 11/30/22.

Food Service:
The home does not have any dishes, cups, or flatware in the kitchen cabinets, inspected, and in good repair. Knives, cutlery, and other sharp kitchen utensils are not stored in a locked drawer. The home is in the process of acquiring these items. The home does not have an adequate food supply at the time of the visit. The kitchen counters are in the process of being installed.

Smoke Detectors:
Smoke and carbon monoxide detectors were installed throughout the interior space. Hardwired smoke detectors were in all three (3) bedrooms and hallways. Carbon monoxide is combined with smoke detectors.

Toxins:
The applicant does not have a locked cabinet to store toxins. The items will be stored in the kitchen area under the kitchen sink cabinet and in the garage but as of this visit, no locks.

Stove burners, oven, microwave, washer, and dryer are in the process of being installed but is not ready for residents as of this visit. The kitchen counters are being installed along with a dish washer. There is one (1) refrigerator in the garage that is working. The home is equipped with central heaters and air conditioning systems.

Report continued on LIC809-C

SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Perry Scott
LICENSING EVALUATOR SIGNATURE:	DATE: 10/06/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/06/2023

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: WRIGHTS NON MEDICAL HOME CARE PROVIDERS SERVICES	FACILITY NUMBER: 198320314
	VISIT DATE: 10/06/2023

NARRATIVE

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Water Temperature:
The water temperature is 139.2 degrees in the bathroom. The kitchen area does not currently have a sink.

Medications, First-Aid Kit & Book:
The home does not have a first aid kit or manual. The resident’s medications will be stored in the kitchen area, but it does not have a lock for the cabinet.

Resident & Staff Files:
The applicant will be handling the cash resources for the residents but does not have a designated locked cabinet for it. Records of staff and residents will be stored in a cabinet in the office area but does not have a cabinet with a lock for the items as of this visit.

Reading Material, Games, Equipment & Materials:
The facility has board games, books, magazines, and other recreational materials for the resident's use that is stored in the garage.

Pool/Jacuzzi & Pets:
There are no pets, jacuzzi, or pools on the premises.

Fire clearance:
A Fire Clearance inspection was conducted on 12/12/22 approved for a capacity for six (6) ambulatory, and zero (0) non-ambulatory.

Component III:
LPA Scott did not conduct the Component III PowerPoint because the applicant is not ready to be licensed.

Report continued on LIC809-C

SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Perry Scott
LICENSING EVALUATOR SIGNATURE:	DATE: 10/06/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/06/2023

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: WRIGHTS NON MEDICAL HOME CARE PROVIDERS SERVICES	FACILITY NUMBER: 198320314
	VISIT DATE: 10/06/2023

NARRATIVE

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LPA observed the following deficiencies that need to be corrected prior to being licensed:

Flooring needs to be completed in the bedrooms and bathrooms. A stove and refrigerator need to be installed in the kitchen, along with a sink with running water. Hazards and obstructions need to be removed from interior and exterior of the home. Adequate food supply needs to be addressed. All cabinets that will be used for staff/resident files, medication, sharps, and toxins need to have a lock. Disaster plan, emergency phone numbers, and all other required postings need to be posted. Grab bars and skid-mats need to be in the upstairs bathroom. Required furniture per title 22 regulations need to be in resident’s bedroom (e.g., nightstand, dresser, lamp, etc.). Night lights need to be installed in hallways and passages to nonprivate bathrooms. Water temperature is 139.2 degrees. It needs to be within 105-120 degrees per title 22 regulations. Prior to being licensed these items must be completed.

An exit interview was conducted, and a copy of this report has been furnished to the applicant, Herbert Wright.

LPA Scott will submit a copy of this facility evaluation report to the Central Applications Unit (CAU) for review. If the applicant has questions regarding the status of the application, they have been instructed to communicate with the CAU Analyst assigned to their application.

SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Perry Scott
LICENSING EVALUATOR SIGNATURE:	DATE: 10/06/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/06/2023

LIC809 (FAS) - (06/04)

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