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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198600371
Report Date: 01/26/2022
Date Signed: 01/26/2022 03:09:25 PM

Document Has Been Signed on 01/26/2022 03:09 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 - DUNROBINFACILITY NUMBER:
198600371
ADMINISTRATOR:GILBERT CARDENASFACILITY TYPE:
735
ADDRESS:12363 DUNROBIN AVETELEPHONE:
(562) 396-0043
CITY:DOWNEYSTATE: CAZIP CODE:
90240
CAPACITY: 4CENSUS: 4DATE:
01/26/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:45 PM
MET WITH:Stephanie Johnson, Lead StaffTIME COMPLETED:
03:20 PM
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On 1/26/2022, Licensing Program Analyst (LPA) Cynthia Chan conducted the required annual inspection using the Infection control practices domain. LPA arrived unannounced and met with Lead Staff, Stephanie Johnson, and explained the purpose of the visit. The facility is licensed to serve 4 ambulatory Developmentally Disabled Adults ages 18 through 59. There are currently 4 ambulatory clients residing at the home who receive services provided by the South Central Regional Center.

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, and a detached garage. There are no pool or bodies of water. There are no obstructions to the passageways, inside and out.
* Staff stated they take the temperature of clients in the morning and evening and staff on every shift.
* LPA observed some signage at the front door and inside the home.
* LPA observed staff wearing face masks properly during the visit.
* The smoke detectors and carbon monoxide detector were tested and functional.
* The hot water temperature was measured between 105-120 degrees Fahrenheit.
* Food supplies of 2 day perishable and a week of nonperishable were observed.
* knives and cleaning solutions are stored and locked in the kitchen cabinets.
* Medications were reviewed for all 4 clients and LPA did not observed any discrepancies with medications and documentation.

LPA provided the following technical assistance to the lead staff:
* N95 Fit Testing resources
* LPA recommended to add a few more signage such as cough/sneeze etiquette to be posted in the common area and hand washing signs in the bathroom and kitchen.

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)
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