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

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198600257
Report Date: 01/27/2022
Date Signed: 01/27/2022 04:07:34 PM

Document Has Been Signed on 01/27/2022 04:07 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:HOUSE OF ST. JOSEPHFACILITY NUMBER:
198600257
ADMINISTRATOR:DURHAM, EDMOND F.FACILITY TYPE:
735
ADDRESS:2632 WEST 16TH PLACETELEPHONE:
(323) 419-0441
CITY:LOS ANGELESSTATE: CAZIP CODE:
90019
CAPACITY: 15CENSUS: 10DATE:
01/27/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:45 PM
MET WITH:Edmond DurhamTIME COMPLETED:
03:00 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) Alma Gonzalez conducted an unannounced Annual Required / Infection Control visit to the above facility. LPA was met by Administrator Edmond Durham and the purpose of today’s visit was explained.

The facility is licensed to serve mentally disabled adults ages 18 to 59 years old, ambulatory only.

The facility is located in a residential area and consists of a two-story (4 attached Units) facility includes: First floor Unit 1: Living room, dining area, kitchen, 2 bathrooms, 2 staff bedrooms and office: First floor Unit 2: Living room, half kitchen/storage, 2 bedrooms and 1 bathroom. Second floor: Unit 1: Living room, half kitchen/storage, storage room, 2 bathrooms and 4 bedrooms: Second floor Unit 2: Living room, half kitchen/storage, 2 bathrooms, 4 bedrooms.



LPA and Administrator Edmond Durham toured the entire facility inside and out. Physical plant inside and outside is in good repair. All client rooms were checked and observed to have the required furniture for comfort and safety such as bed frames, dressers, lamps and chairs and all had sufficient lighting. Clients beds have the required linens which were in good condition at the time of the visit. All bedrooms had sufficient closet/ storage space. Bathrooms are clean and operational and were observed to be within Title 22 regulations. Toilets and water faucets worked properly. Shower was free of mold/mildew, adequate lighting, and sufficient toiletries are accessible to clients. Water temperature properly measured at 105F*. Facility temperature was comfortable. LPA observed the facility to be clean and appropriately furnished with clear passageways inside and outside. First aid kit is fully stocked with manual, smoke detectors and carbon monoxide detector were in compliance and operational. No firearms are stored at facility and no bodies of water present. Medications are stored, locked and inaccessible to clients. Ample supply of perishable and nonperishable food, hazardous toxins and/or items are inaccessible to clients, fire extinguisher is fully charged. Exit, walkways and/or passageways, front and back yard are free of debris and/or hazards. The facility is in good repair.

Report continues on LIC809C)

SUPERVISORS NAME: Rebecca Orendain
LICENSING EVALUATOR NAME: Alma Gonzalez
LICENSING EVALUATOR SIGNATURE: DATE: 01/27/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/27/2022
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 2
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 CNTR DR. ST 500
MONTEREY PARK, CA 91754
FACILITY NAME: HOUSE OF ST. JOSEPH
FACILITY NUMBER: 198600257
VISIT DATE: 01/27/2022
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
26
27
28
29
30
31
32
The following were observed/inspected:
  • COVID-19 Infection Control Practices (including signs) were observed at the entrance of this facility, and in all common rooms bathrooms and hallways.
  • Clients are able to use a designated isolation room that will be used as isolation room if a COVID-19 positive case should arise.
  • 30 day supply of medication for clients
  • Facility has an adequate amount of PPE and facility has enough PPE for 30 days.
  • Clients were socially distanced according to local public health guidelines.
  • Staff responsible for direct care and supervision were observed wearing masks.
  • Sufficient supply of perishable for 2 days and non-perishable foods for 7 days were observed.
  • Hand Sanitizer: Available throughout the facility for client use.
  • The clients temperature's are checked and logged once a day.
  • Staff temperatures are checked and logged twice a day or anytime shift changes.
  • Staff and clients are tested weekly for COVID-19.

Exit interview conducted, a copy of this report was provided to Administrator Edmond Durham.
SUPERVISORS NAME: Rebecca Orendain
LICENSING EVALUATOR NAME: Alma Gonzalez
LICENSING EVALUATOR SIGNATURE:

DATE: 01/27/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/27/2022
LIC809 (FAS) - (06/04)
Page: 2 of 2