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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198320314
Report Date: 01/11/2024
Date Signed: 01/11/2024 02:45:22 PM

Document Has Been Signed on 01/11/2024 02:45 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, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245
FACILITY NAME:WRIGHTS NON MEDICAL HOME CARE PROVIDERS SERVICESFACILITY NUMBER:
198320314
ADMINISTRATOR:WRIGHT, HERBERTFACILITY TYPE:
736
ADDRESS:16331 SOUTH TARRANT AVENUETELEPHONE:
(909) 693-0441
CITY:CARSONSTATE: CAZIP CODE:
90746
CAPACITY: 6CENSUS: 0DATE:
01/11/2024
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
09:28 AM
MET WITH:HERBERT WRIGHTTIME COMPLETED:
10:57 AM
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On 01/11/24, LIcensing Program Analyst (LPA) Ernand Dabuet conducted a subsequent prelicensing visit to inspect corrections dated 10/06/23 during the initial pre licensing inspection conducted by LPA Perry Scott. LPA met with applicant Herbert Wright and explained the the purpose of the visit.

During this visit LPA inspected the following:
  • Flooring in bathrooms: corrected 01/11/24
  • Flooring in bedrooms: corrected 01/11/24
  • Operable stove: corrected 01/11/24
  • Operable refrigerator: corrected 01/11/24
  • Adequate food supply: corrected 01/11/24
  • Grab bars and non-skid mats: corrected 01/11/24
  • Clients Funds (stored in Sentry Safe) corrected 01/11/24
  • Sharp objects (stored in Sentry Safe in kitchen cabinet) corrected 01/11/24
  • Medications (stored in locked kitchen cabinet) corrected 01/11/24
  • Staff and Client Files (stored in a locked office cabinet)
  • Running water in kitchen sink: corrected 01/11/24
  • Hot water temperature: corrected 01/11/24
  • Exterior obstruction of objects/materials: corrected 01/11/24
  • Operable night lights in hallways: corrected 01/11/24
  • Resident's room furnishings: night stand, dresser, lamp, linens: corrected 01/11/24
  • All required CCL posted materials: corrected 01/11/24

Evaluation Report continues LIC 809-C
SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Ernand Dabuet
LICENSING EVALUATOR SIGNATURE: DATE: 01/11/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/11/2024
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, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245
FACILITY NAME: WRIGHTS NON MEDICAL HOME CARE PROVIDERS SERVICES
FACILITY NUMBER: 198320314
VISIT DATE: 01/11/2024
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Component III:
LPA Dabuet conducted at the Pre-Licensing visit, information provided about how to operate the facility within substantial compliance.

LPA observed all corrections were corrected during the inspection visit.

An exit interview was conducted, and a copy of this report has been furnished to the applicant, Herbert Wright. Accordingly, LPA Dabuet 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: Ernand Dabuet
LICENSING EVALUATOR SIGNATURE:

DATE: 01/11/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/11/2024
LIC809 (FAS) - (06/04)
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