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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198600371
Report Date: 02/06/2023
Date Signed: 02/06/2023 02:31:18 PM

Document Has Been Signed on 02/06/2023 02:31 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
GREATER LA AC/SC, 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:
02/06/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:43 AM
MET WITH:Lan Ly - AdministratorTIME COMPLETED:
02:45 PM
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Licensing Program Analyst (LPA) Luis Mora conducted an unannounced annual visit at the facility with focus on the infection control domain, medication and food review. LPA Mora met with Lan Ly (Administrator). The facility is licensed to serve 4 developmentally disabled clients in the age range of 18 through 59, ambulatory clients only. The facility is operating within the scope of its license.

LPA and Administrator toured the home and inspected 3 client bedrooms, 1 bathrooms, kitchen, dining area, living room, front yard, backyard, and detached garage. The front and backyard are well maintained and there are no pools or large bodies of water. There is a shaded seating area for the clients located in the backyard. Passageways and exits are free of obstruction. The water temperature was tested in the bathroom and measured at 112.4 degrees F which is within the required 105 - 120 degrees. Client bedrooms have the required furniture such as bed frames, dressers, lamps and chairs. Bedrooms also have sufficient closet space. Client beds have the required linen and the linen is in good condition. There is a cabinet in the hallway with extra clean linen and towels. Smoke detectors were observed in each room and throughout the facility and were operable. There is a carbon monoxide in the hallway and it was operable. There is a fire extinguisher located in the kitchen which is fully charged. Kitchen appliances are clean and were operating at the time of the visit. Sufficient supply of 2 days perishable & 7 days non-perishable foods were observed in the kitchen. Sharps are locked in a kitchen cabinet and are inaccessible to clients. Cleaning supplies and toxins are locked under the kitchen sink and are inaccessible to clients. First Aid kit was fully stocked with current manual and it is kept locked in a kitchen cabinet. Signs are posted throughout the facility to promote hand washing, cough/sneeze etiquette, and physical distancing. Medications are centrally stored in a locked kitchen cabinet. Client and staff files are kept locked in living room cabinet. All four of the client files and medications were reviewed and no deficiencies were found. Medications are documented properly and given as prescribed. Six staff files were reviewed and no deficiencies were found.

(Continued to LIC 809C)
SUPERVISORS NAME: Wei Siew Ho
LICENSING EVALUATOR NAME: Luis Mora
LICENSING EVALUATOR SIGNATURE: DATE: 02/06/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/06/2023
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 - DUNROBIN
FACILITY NUMBER: 198600371
VISIT DATE: 02/06/2023
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Per California Code of Regulations, Title 22, and California Health and Safety Code, there were no deficiencies observed during the visit. Exit interview held and a copy of the report was provided.
SUPERVISORS NAME: Wei Siew Ho
LICENSING EVALUATOR NAME: Luis Mora
LICENSING EVALUATOR SIGNATURE:

DATE: 02/06/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/06/2023
LIC809 (FAS) - (06/04)
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