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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198600052
Report Date: 12/21/2021
Date Signed: 12/21/2021 03:11:58 PM

Document Has Been Signed on 12/21/2021 03:11 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
CCLD Regional Office, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754
FACILITY NAME:HERITAGE ADULT RESIDENTIAL KAREFACILITY NUMBER:
198600052
ADMINISTRATOR:ODUNOLA TAIWOFACILITY TYPE:
735
ADDRESS:640 WEST CALDWELL AVENUETELEPHONE:
(310) 763-2829
CITY:COMPTONSTATE: CAZIP CODE:
90220
CAPACITY: 6CENSUS: DATE:
12/21/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH:Demarest Glenn-DSPTIME COMPLETED:
12:50 PM
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Licensing Program Analyst (LPA) Martessa Brown conducted an unannounced Annual required visit with a primary focus was infection control measures. LPA was met by Demarest Glenn, DSP and the purpose of today’s visit was explained. The facility is licensed to serve 6 developmentally disabled clients (age 18-59).

There are currently (4) South Central Regional Center clients in placement. All (4) clients are ambulatory. The facility is a single story structure located in a residential neighborhood. It consists of the following: 4 bedrooms, 3 bathrooms, family room/dining room, kitchen, living rooms, shaded area, indoor and outdoor activity area, laundry room and an attached garage.



LPA and staff toured the physical plant. There are no bodies of water or firearm/ammunition on the premises. All client rooms were checked. Beds and bedding were in good condition, adequate lighting provided, storage for client personal belongings was observed. Bed linens, comforters, and bath towels were adequately stocked at the time of visit. Bathrooms were found to be within Title 22 regulations and were clean and operational. The water temperature measured in bathroom #1 105.5 1F, #2 104.5 and #3 double sinks were 104.5. A comfortable temperature is maintained in the facility. LPA observed the facility to be clean and appropriately furnished at the time of visit. Storage areas for personal hygiene, cleaning agents, toxins, and sharps were inaccessible to clients. The kitchen was inspected and there is a enough perishable and non-perishable food available which is stored properly. Fire extinguisher was charged, smoke detectors and Carbon Monoxide were operable.

During the visit, LPA observed the facility infection control practices. LPA observed sanitizing stations located in common areas. Residents were not in the home due to being at the day program. LPA observed staff wearing face coverings, an residents are able to isolate in there own rooms and LPA observed posting. LPA observed the facility has a 30-day supply of Personal Protective Equipment (PPE).
LIC 809-C is on the next page.
SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Martessa Brown
LICENSING EVALUATOR SIGNATURE: DATE: 12/21/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/21/2021
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
CCLD Regional Office, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754
FACILITY NAME: HERITAGE ADULT RESIDENTIAL KARE
FACILITY NUMBER: 198600052
VISIT DATE: 12/21/2021
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LPA advised the Administrator to continuously monitor the Centers for Disease Control (CDC) website and Community Care Likening Provider Informational Notices (PIN) for any updates relating to COVID-19 guidance.

Deficiencies may be issued at a later time.

Exit interview held. A copy of the report was provided Demarest Glenn.

SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Martessa Brown
LICENSING EVALUATOR SIGNATURE:

DATE: 12/21/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/21/2021
LIC809 (FAS) - (06/04)
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