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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198320371
Report Date: 05/30/2023
Date Signed: 05/30/2023 11:24:29 AM

Document Has Been Signed on 05/30/2023 11:24 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, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754
FACILITY NAME:BROOKS PLACE IIFACILITY NUMBER:
198320371
ADMINISTRATOR:FLEMINGS, CHARLESFACILITY TYPE:
735
ADDRESS:844 GLENWAY DR.TELEPHONE:
(310) 819-8369
CITY:INGLEWOODSTATE: CAZIP CODE:
90302
CAPACITY: 4CENSUS: 0DATE:
05/30/2023
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
09:09 AM
MET WITH:Charles FlemingsTIME COMPLETED:
11:45 AM
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On 5/30/23, Licensing Program Analyst (LPA) Felisa Shirley met with Administrator Charles Flemings and conducted an announced visit to the facility for the purpose of a Pre - licensing evaluation as an application was submitted to CCLD for an Initial license. The residential care facility is to accommodate residents ages 18 – 59 and is approved for four (4) Ambulatory residents. Fire Clearance was approved for (4) four ambulatory residents.

Facility is a single-story home with 4-bedrooms, 3 bathrooms, a kitchen, a laundry area, outdoor area with a Sun Shade Sail/Canopy for shade. The client bedrooms are spacious and will easily accommodate the client's furnishings and belongings. All passageways, walkways, driveway and patios are free from obstructions. The water delivered at 115.8.

All bathrooms have a working toilet, wash basin and a shower with handrails.

Beds have the required linen/supplies which include, pillowcase, mattress pads, fitted sheet, blanket and bedspreads. Additional supplies are stored in the linen closet.

Emergency plan, emergency exit plans and emergency phone numbers are all posted & readily available for review in entryway. There is 1 fire Extinguisher located in kitchen. Facility has a landline, one phone located in the living room.
Seven days of perishables and thirty plus days on non-perishables are adequately stored in kitchen fridge. Appliances in kitchen properly installed and functioning. Stove burners, oven, and microwave all in good working condition. There is one refrigerator in the home as well. Smoke detectors and carbon monoxide detectors are all hardwire and interconnected, all are operational.

Con'd on 809C
SUPERVISORS NAME: Stephanie Cifuentes
LICENSING EVALUATOR NAME: Felisa Shirley
LICENSING EVALUATOR SIGNATURE: DATE: 05/30/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/30/2023
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: BROOKS PLACE II
FACILITY NUMBER: 198320371
VISIT DATE: 05/30/2023
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A first aid kit has been inspected and has at least the following: thermometer, tweezers, scissors, antiseptic, bandages, gauze and current first aid manual is being ordered which will be available for staff use but inaccessible to clients.

Component III was completed on 05/30/2023 with Charles Flemings to discuss information about how to operate the facility within substantial compliance.

During the pre-licensing inspection LPA noted that there was no First Aid manual; By the end of the visit the Director showed proof of order on Amazon and manual will be delivered tomorrow 5/31/23.

An exit interview was conducted, and a copy of this report has been furnished to the applicant. Accordingly, LPA will submit a copy of this facility evaluation report to the Central Applications Bureau (CAB) for review. If the applicant has questions regarding the status of the application, they have been instructed to communicate with the CAB Analyst assigned to their application.
SUPERVISORS NAME: Stephanie Cifuentes
LICENSING EVALUATOR NAME: Felisa Shirley
LICENSING EVALUATOR SIGNATURE:

DATE: 05/30/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/30/2023
LIC809 (FAS) - (06/04)
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