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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198600241
Report Date: 06/12/2024
Date Signed: 06/12/2024 10:32:57 AM

Document Has Been Signed on 06/12/2024 10:32 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
MONTEREY PARK ASC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754
FACILITY NAME:CHOICES R US - SPRYFACILITY NUMBER:
198600241
ADMINISTRATOR/
DIRECTOR:
BRADFORD, SHAJUANAFACILITY TYPE:
735
ADDRESS:9614 SPRY STTELEPHONE:
(562) 302-0348
CITY:DOWNEYSTATE: CAZIP CODE:
90242
CAPACITY: 6CENSUS: 6DATE:
06/12/2024
TYPE OF VISIT:Case Management - Health ChecksUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:12 AM
MET WITH:Shajuana Bradford, DirectorTIME VISIT/
INSPECTION COMPLETED:
10:45 AM
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Licensing Program Analyst (LPA) Sanjay Vaid made an unannounced Case Management visit to the facility. LPA was greeted by Stephanie Johnson- DSP and explained the reason for the visit. Spoke to Shajuana Bradford -Director arrived 30 minutes later and assisted with the case management visit and facility tour.

The purpose of the visit is to conduct a Health and Safety Check in regards to a special incident report that was received on 01/18/2024, regarding an alleged sexual abuse incident that occurred involving two clients.

On 01/18/2024, the Monterey Park Regional Office received an Unusual Incident Report indicating that Client #1 (C1) had told staff during quarterly meeting that, Client #2 (C2) got naked and tried to do things to C1. C1 stated this incident took place two years ago. When C2 was asked by Administrator of the incident C2 answered with a obscene remark ”f_ck you b_tch” . Clients #1 and Client #2 have delusions and behaviors according to health, medical and psychiatric progress notes. Both C#1 and C#2 are at day program, and have been residing in separate rooms after the incident. Both clients are happy with new roommates, according to the Administrator and staff.

LPA Vaid conducted a Health and Safety check visit on 06/12/24 in response to the Unusual Incident Report that was received. LPA obtained copies of the following from Resident #1 and #2 (R1 and R2) files: Client roster, Physician Report, Medication List. Staff roster, Appraisal/Needs and Service Plan, Psychiatric Services Progress Notes to be emailed to LPA.

LPA toured the facility, which included common areas and a random. LPA did not observe any immediate health and/or safety concerns and no deficiencies were cited during today’s visit.
SUPERVISORS NAME: Fernando Fierros
LICENSING EVALUATOR NAME: Sanjay Vaid
LICENSING EVALUATOR SIGNATURE: DATE: 06/12/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/12/2024
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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