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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198320390
Report Date: 08/22/2025
Date Signed: 08/26/2025 01:08:43 PM

Document Has Been Signed on 08/26/2025 01:08 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:PERSON CENTERED OPTIONS IIFACILITY NUMBER:
198320390
ADMINISTRATOR/
DIRECTOR:		CHENIA L JEFFERSONFACILITY TYPE:
735
ADDRESS:1402 E. WASHINGTON STREETTELEPHONE:
(909) 904-2913
CITY:LONG BEACHSTATE: CAZIP CODE:
90805
CAPACITY: 3CENSUS: 3DATE:
08/22/2025
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:08 AM
MET WITH:Monique WeatherspoonTIME VISIT/
INSPECTION COMPLETED:
11:46 AM
NARRATIVE
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On 08/22/25, Licensing Program Analyst (LPA) Villegas conducted a subsequent case management visit in response to an unusual incident report that was submitted to CCLD on 07/25/25. The unusual incident report documented an incident that occurred on 07/25/25; regarding client #1 (C1), and staff #1 (S1). LPA met with Monique Weatherspoon as the purpose of the visit was explained.

The investigation consisted of the following: On 08/05/25 LPA obtained copies of the following for staff #1 (S1): resume, statement acknowledging requirement to report suspected abuse of dependent adults and elders (SOC 341), Direct support professional (DSP) job description, and copies of the following in-services: NOC proactive strategies for NOC shift, function of behavior, ABC contingencies, and documentation, Behavior management and staff duties, break log, shift duties, cell phones, documentation training, documentation and individualize behavior support plans, BCBA behavioral training, corrective actions, evaluations, terminations/ resignations, HCBS final rule, and corrective actions. On 08/05/25 LPA obtained copies of the following for client #1 (C1): face sheet, physicians report, needs and service plan/IPP, medication list, behavior report, and body check form dated 07/25/25. On 08/05/25 LPA conducted an interview with C1 and S2-S5. On 08/05/25 LPA unable to interview S1 as S1 is no longer employed at Person Centered Options II. On 08/22/25 LPA conducted an interview with Client 2-3 (C2-C3).

The investigation revealed the following: On 08/05/25 LPA conducted an interview with C1, C1 confirmed the incident that occurred on 07/07/25 and reported exiting the facility through the back gate which was opened. On 08/05/25 LPA conducted an interview with S2-S5, 3 of 4 staff interviewed reported not being on shift the day the incident occurred 07/07/25 and reported they have never left clients in care at the facility unsupervised. 1 of 4 staff interviewed confirmed incident that occurred on 07/07/25 and reported being made aware of the incident on 07/07/25 at 2am via telephone call from Licensee. 1 of 4 staff continued to

NAME OF LICENSING PROGRAM MANAGER: Janae Hammond
NAME OF LICENSING PROGRAM ANALYST: Lizeth Villegas
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 08/22/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/22/2025
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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California Health & Human Services Agency
California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:
  • Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.
  • Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)
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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: PERSON CENTERED OPTIONS II
FACILITY NUMBER: 198320390
VISIT DATE: 08/22/2025
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report that a body check was conducted on C1, and S1 was relieved from S1’s duties immediately. On 08/05/25 LPA unable to interview S1 as S1 is no longer employed at Person Centered Options II. On 08/22/25 LPA conducted an interview with Client 2-3 (C2-C3) regarding the incident that occurred on 07/07/25, 2 of 2 clients interviewed confirmed the incident and reported the police arrived to the facility with C1, per 2 of 2 clients interviewed S1 was not at the facility upon police arrival.

Exit interview conducted, appeal rights explained, and a copy of this report was provided.

NAME OF LICENSING PROGRAM MANAGER: Janae Hammond
NAME OF LICENSING PROGRAM ANALYST: Lizeth Villegas
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 08/22/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/22/2025
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 08/26/2025 01:08 PM - It Cannot Be Edited


Created By: Lizeth Villegas On 08/22/2025 at 09:41 AM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245

FACILITY NAME: PERSON CENTERED OPTIONS II
FACILITY NUMBER: 198320390

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/22/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
08/29/2025
Section Cited
CCR
85064(j)(2)

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85064 Administrator Qualifications and Duties The administrator shall perform the following duties:Development of an administrative plan and procedures to define lines of responsibility, workloads, and staff supervision.Based on interviews, the licensee/administrator did
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The Licensee/administrator will review the staff schedule and will make arrangements to ensure a staff member is always present while clients are at the facility receiving care. The Administrator will submit plan to LPA by POC due date.
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not comply with the section cited above as the administrator did not ensure there were staff available at facility to monitor clients in care which poses/posed a potential health, safety or personal rights risk to persons in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Janae Hammond
NAME OF LICENSING PROGRAM MANAGER:
Lizeth Villegas
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 08/22/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/22/2025


LIC809 (FAS) - (06/04)
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