198600241-6-26-2023-28-AS-KRAZ-CT6LFZ-20230626084354

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 198600241
Report Date: 06/24/2023
Date Signed: 06/26/2023 08:44:40 AM

Document Has Been Signed on 06/26/2023 08:44 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
GREATER LA AC/SC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754

FACILITY NAME:	CHOICES R US - SPRY		FACILITY NUMBER:	198600241
ADMINISTRATOR:	BRADFORD, SHAJUANA		FACILITY TYPE:	735
ADDRESS:	9614 SPRY ST		TELEPHONE:	(562) 302-0348
CITY:	DOWNEY	STATE: CA	ZIP CODE:	90242
CAPACITY: 6		CENSUS: 6	DATE:	06/24/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	08:32 AM
MET WITH:	SHAJUANA BRADFORD		TIME COMPLETED:	12:30 PM

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Licensing Program Analyst (LPA) Kimberly Ramirez conducted an unannounced Annual Required Visit on 06/24/2023 at 8:34 Am. LPA was met by Staff #1 (S1) and explained the purpose of the visit. S1 assisted in tour of facility. Administrator Shajuana Bradford arrived shortly after to the facility. There are six (6) level 4I developmentally disabled clients in the home. The facility is licensed for clients 18-59 years old. The facility has a fire clearance approved for six (6) ambulatory. All clients receive services from South Central Los Angeles Regional Center. LPA requested and obtained a copy of Personnel Report, and Resident Roster.

LPA OBSERVATIONS: Tour began at 9:00 am and was led by Administrator Bradford. The facility is a single-story building located in a residential area with three (3) client bedrooms, two (2) bathrooms, kitchen, dining room, den/TV room, living room, front yard, backyard, and shed.

· Front Yard: Was clean and well maintained. No hazards were observed.

· Kitchen: LPA observed kitchen to be clean and appliances appeared to be in working order. LPA observed sufficient 2 days of perishables and 7-day supply on non-perishables. LPA observed knives and sharps located in top kitchen cabinet, to be inaccessible to 6 (six) out of 6 (six) clients in care. LPA observed several bottles of cleaning solutions and disinfectants located in bottom kitchen cabinet to be inaccessible to 6 (six) out of 6 (six) clients in care. Kitchen sink water temperature was measured at 112.8 degrees F.

· Dining Room/Living room/Den: Dining room was observed to be clean and contained one table with plenty of seating. Living room was observed plenty of seating and lighting. Den/TV room contained plenty of seating and LPA Ramirez observed clients watching TV during visit.

· Linen Closet: Contained plenty linens, towels, and hygiene products.

· Client Rooms 1 - 3: Bedrooms 1 - 2 contained the required furnishings, lighting and linens. Bedrooms were observed to be clean with plenty of closet space. LPA Ramirez attempted to gain entry into client bedroom #3, client #6 (C6) denied LPA Ramirez and staff entry. Staff attempted to coach C6 into allowing LPA Ramirez into room but, C6 refused and due to personal rights, LPA Ramirez and staff obliged.

SUPERVISORS NAME: Tony Vasallo
LICENSING EVALUATOR NAME: Kimberly Ramirez
LICENSING EVALUATOR SIGNATURE:	DATE: 06/24/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/24/2023

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
GREATER LA AC/SC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754

FACILITY NAME: CHOICES R US - SPRY	FACILITY NUMBER: 198600241
	VISIT DATE: 06/24/2023

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· Bathrooms: Shared client bathroom# 1 was observed to be clean and contained soap and paper towels. Signs promoting hand washing were observed. Water temperature in this bathroom was measured at 113.7 degrees F which is in the required 105 – 120 degrees F. Bathroom #2 was observed to be clean and water temperature was measured at 111.3 degrees F which is in the required 105 – 120 degrees F.

· Centrally Stored Medications: LPA observed cabinet located in hallway to be locked and inaccessible to residents. LPA reviewed six (6) out of six (6) client medications and Medication Administration Record (MAR).

· Backyard: Clean and free from hazards. LPA observed plenty of seating and shade. No large bodies of water were observed. LPA observed locked shed that contained cleaning supplies and PPE.

LPA observed carbon monoxide in hallways. Smoke detector is hard wired and tested during visit. Administrator certificate was observed for Shajuana Bradford with an expiration date of 09/04/23. Last fire drill/earthquake was conducted on 06/01/23. Six (6) out of six (6) clients records were reviewed. Seven (7) staff files were reviewed. LPA Ramirez reviewed Infection Control Plan. Administrator Bradford shall email to LPA Ramirez Infection Control Plan within 7 days of this visit.

No deficiencies are being cited during visit. Exit interview was conducted with Administrator Bradford and a copy of this report was provided via email due to printer problems.

SUPERVISORS NAME: Tony Vasallo
LICENSING EVALUATOR NAME: Kimberly Ramirez
LICENSING EVALUATOR SIGNATURE:	DATE: 06/24/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/24/2023

LIC809 (FAS) - (06/04)

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