<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198600187
Report Date: 01/26/2022
Date Signed: 01/26/2022 12:56:35 PM

Document Has Been Signed on 01/26/2022 12:56 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 CNTR DR. ST 500
MONTEREY PARK, CA 91754
FACILITY NAME:CHOICES R US - IZETTAFACILITY NUMBER:
198600187
ADMINISTRATOR:DANIEL GODFREYFACILITY TYPE:
735
ADDRESS:12103 IZETTA AVETELEPHONE:
(562) 869-5135
CITY:DOWNEYSTATE: CAZIP CODE:
90242
CAPACITY: 4CENSUS: 3DATE:
01/26/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:45 AM
MET WITH:Allen Scott, DSPTIME COMPLETED:
01:15 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
Licensing Program Analyst (LPA) Cynthia Chan conducted the required annual inspection using the Infection control practices domain. LPA arrived unannounced and met with DSP Allen Scott and explained the purpose of the visit. The facility is licensed to serve 4 Ambulatory Developmentally Disabled Adults ages 18 through 59. The home is vendored by the South Central Los Angeles Regional Center. There are currently 3 ambulatory clients residing at the home. The facility has an approved mitigation plan.

LPA toured the facility with the Staff and observed or inspected the following:
* The facility has 3 bedrooms, 1 bathroom, living room, kitchen with dining area, open office area with laundry machine, and a detached garage. There are no pool or bodies of water. There are no obstructions to the passageways. The clients currently have their own rooms.
* Staff took LPA's temperature upon arrival. Staff stated they take the temperature of clients and staff at least twice a day.
* LPA observed signage at the front door and inside the home. LPA recommended to add a few more signage such as cough/sneeze etiquette and symptoms check to be posted in the common areas.
* Staff was wearing N95 during visit and stated that staff wear masks at all times when working with clients.
* The fire extinguishers were last inspected on July 1, 2021. The smoke detectors and carbon monoxide detector are operational.
* The hot water temperature was measured between 105-120 degrees Fahrenheit.
* LPA observed the disinfectants, cleaning solutions, extra hygiene supplies, and knives locked in the cabinets.
* Medications were reviewed for all 3 clients and LPA did not observed any discrepancies with medications and documentation.
**LPA spoke to the Administrator Daniel Godfrey over the phone to provide information on the N95 Fit Testing and emailed the resources.
There are no deficiencies issued today. An exit interview was conducted and a copy of this report along with appeal rights were given.
SUPERVISORS NAME: Lisa Hicks
LICENSING EVALUATOR NAME: Cynthia D Chan
LICENSING EVALUATOR SIGNATURE: DATE: 01/26/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/26/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 1