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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198320330
Report Date: 04/25/2024
Date Signed: 04/25/2024 10:37:06 AM


Document Has Been Signed on 04/25/2024 10:37 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, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245



FACILITY NAME:HEARTS UNITED INCFACILITY NUMBER:
198320330
ADMINISTRATOR:STEVENS, DONNAFACILITY TYPE:
735
ADDRESS:2427 W 239TH STTELEPHONE:
(310) 371-1750
CITY:TORRANCESTATE: CAZIP CODE:
90501
CAPACITY:2CENSUS: 2DATE:
04/25/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
09:14 AM
MET WITH:ADMINISTRATOR DONNA STEVENSTIME COMPLETED:
11:00 AM
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On 04/25/2024 around 9am Licensing Program Analysts (LPA) Jose Calderon conducted an announced visit to Harts United Inc Facility 2427 W 239th Street Torrance CA 90501 and met with Administrator Donna Stevens for purpose of closing the facility to move to new location. Administrator states that the property owner is selling the property and she will have to move by 04/26/2024. LPA Calderon noted many boxes with physical plant items located throughout the facility. The capacity is for 2 ambulatory Adult Resident Facility.

Facility is a 3 bedroom, 2 bathrooms, one-story house. The client bedrooms are spacious and will easily accommodate the client's furnishings. There is a backyard with a covered patio for shade. The patio contained 1 small table and 3 chairs. Outdoor passageways, walkways, driveways, steps and patios are free from obstructions. LPA did not observe hazards, such as ladders, gardening tools and/or motorized equipment in the front, back and/or side areas of the facility. Residents Bedrooms: All 3 Bedrooms are for ambulatory clients. Bedroom’s #1 and #2 and #3 has one bed each, one chair, one-night stand, one lamp, dresser. Bedrooms #1, #2 and #3 all comply with the requirement of 8 cubic feet of space.

SUPERVISOR'S NAME: Ulysses CoronelTELEPHONE: (323) 400-7397
LICENSING EVALUATOR NAME: Jose CalderonTELEPHONE: (323) 213-1153
LICENSING EVALUATOR SIGNATURE:
DATE: 04/25/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/25/2024
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: HEARTS UNITED INC
FACILITY NUMBER: 198320330
VISIT DATE: 04/25/2024
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Bathroom: Have a working toilet, wash basins, and walk-in shower. Bathroom #1 shower has grab bars, but licensee states bathroom #1 is for ambulatory only residents. LPA observed adequate lighting in hallway leading to bathrooms. Linens & Hygiene Supplies: Beds have the required linen/supplies which include, pillowcase, mattress pads, fitted sheet, blanket and bedspreads. Adequate supply of linen stored in hall closet.

Emergency Phone Numbers, Exit Plan & Menu: The telephone system is a land line and operable. Emergency Disaster Plan and "See something, say something Let Us Know" were missing. Fire Extinguisher 1 mounted on the wall in hallway next to the kitchen.


Food Service: 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. Food supply is adequate; stored in kitchen refrigerator and cabinets and consists of the following: A variety of Fresh and Canned fruit, vegetable and meat food items. Smoke Detectors: 6 hard wired smoke detectors are battery and electric. operated & working. Carbon monoxide detector located and mounted in the hallway is operational. Appliances: Gas Stove, oven, microwave, washer, and dryer working. Refrigerator in the kitchen has a measured temperature of at least 37 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. Toxins: Locked/stored in the storage room located in the kitchen. Water Temperature: Bathrooms water temperature tested in #1 at 105 F. and #2 106 F. degrees.
SUPERVISOR'S NAME: Ulysses CoronelTELEPHONE: (323) 400-7397
LICENSING EVALUATOR NAME: Jose CalderonTELEPHONE: (323) 213-1153
LICENSING EVALUATOR SIGNATURE:

DATE: 04/25/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/25/2024
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: HEARTS UNITED INC
FACILITY NUMBER: 198320330
VISIT DATE: 04/25/2024
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Medications, First-Aid Kit & Book: Medication administration records storage area, and first aid kit has been inspected, which are stored in locked kitchen cabinet adjacent the refrigerator, available for staff use but inaccessible to clients.

Clients & Staff Files: Applicant will be handling cash resources of clients and has a surety bond for $2000.00. Cash resources will be locked and stored with P & I Ledger, accessible to designated staff. Records of staff and clients shall be stored in a locked in staff closet and the section has been inspected.

Reading Material, Games, Equipment & Materials: The facility has board games, books, and other recreational materials for the client's use. LPA did not observe any pet or bodies of water at the facility. LPA did not observe delayed egress, chain locks or dead bolts on exits. LPAs did not observe pad locks or other mechanisms which may be obstructions for safe and quick egress during an emergency on side gates and front exits. Pool/Jacuzzi & Pets: LPA did not observe any pet or bodies of water at the facility. Fire clearance: Fire Clearance was approved on 04/17/2024 for 2 ambulatory clients with no special instructions. LPA did not observe delayed egress, chain locks or dead bolts on exits. LPA did not observe pad locks or other mechanisms which may be obstructions for safe and quick egress during an emergency on side gates and front exits.



An exit interview was conducted, and a copy of this report has been furnished to the Administrator Donna Stevens by hand.
SUPERVISOR'S NAME: Ulysses CoronelTELEPHONE: (323) 400-7397
LICENSING EVALUATOR NAME: Jose CalderonTELEPHONE: (323) 213-1153
LICENSING EVALUATOR SIGNATURE:

DATE: 04/25/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/25/2024
LIC809 (FAS) - (06/04)
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