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

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198600462
Report Date: 08/02/2023
Date Signed: 08/02/2023 11:46:32 AM

Document Has Been Signed on 08/02/2023 11:46 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
EL SEGUNDO, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754
FACILITY NAME:MEDING'S HOME CARE IIIFACILITY NUMBER:
198600462
ADMINISTRATOR:ROGELIO S. ROMEROFACILITY TYPE:
735
ADDRESS:1619 WEST 216TH STREETTELEPHONE:
(310) 830-3286
CITY:TORRANCESTATE: CAZIP CODE:
90501
CAPACITY: 6CENSUS: 2DATE:
08/02/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
08:06 AM
MET WITH:Rogelio RomeroTIME COMPLETED:
12:00 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) Antonine Richard conducted an unannounced annual visit on 8/2/2023 at 8:06 AM. Upon arriving at the facility, LPA met with Direct Support Professional (DSP) Mario Lopez who assisted with the visit. The purpose of today’s visit was discussed with DSP. Administrator arrived later and joined the visit. The facility is licensed for six (6) clients, ambulatory only, prefers to serve developmentally disabled adults ages 18 thru 59 years. Harbor Regional Center refer level 3 clients to this facility. The facility annual fees are current during today’s visit.

LPA toured the single-story facility with DSP. This facility consists of two (2) resident bedrooms, one (1) staff bedroom, kitchen, dining area, living room, staff office, two (2) bathrooms (bathroom#2 for staff use only), laundry area, and garage. Currently, there are two (2) clients and two (2) staff present during today’s visit.

During the visit, LPA observed operable smoke detectors in bedrooms and hallways. One operable carbon monoxide detector located in the hallway next to the kitchen. One fire extinguisher is located in the kitchen/dining area. The last facility fire drill was on 07/10/2023. LPA observed the facility to be sanitary and appropriately furnished at the time of visit. The kitchen was inspected and there is sufficient perishable and non-perishable food available.

There are no pools or bodies of water on the premises. There are no firearms on the premises and other dangerous weapons. Centrally stored medications are locked in a cabinet located in the kitchen. The first aid kit has all required supplies.

SUPERVISORS NAME: Ulysses Coronel
LICENSING EVALUATOR NAME: Antonine Richard
LICENSING EVALUATOR SIGNATURE: DATE: 08/02/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/02/2023
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 3
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754
FACILITY NAME: MEDING'S HOME CARE III
FACILITY NUMBER: 198600462
VISIT DATE: 08/02/2023
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 facility has a written emergency disaster plan posted in the bulletin board. The facility is maintained at a comfortable temperature. LPA tested hot water temperature in the common bathroom measures 135.4F to 136.7F degrees Fahrenheit. There are working lights or lamps in each room at the time of visit. There is a grab bar for the toilet and shower used by clients. Shower has non-skid mat.

During the visit, LPA observed the following to be in compliance: facility's infection control practices; screening protocols for visitors, staff, and residents, sanitizing stations in common areas and restrooms; every staff was wearing a face covering; the facility has a 30-day supply of Personal Protective Equipment (PPE). All mandated inspection control posters were posted. The facility has a Mitigation Plan Report approved by CCLD.

Deficiency was cited (see LIC 809D) from the California Code of Regulations, Title 22.

Exit interview conducted and appeal rights discussed. A copy of this report and appeal rights provided to Licensee Rogelio Romero.

SUPERVISORS NAME: Ulysses Coronel
LICENSING EVALUATOR NAME: Antonine Richard
LICENSING EVALUATOR SIGNATURE:

DATE: 08/02/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/02/2023
LIC809 (FAS) - (06/04)
Page: 2 of 3
Document Has Been Signed on 08/02/2023 11:46 AM - It Cannot Be Edited


Created By: Antonine Richard On 08/02/2023 at 11:26 AM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754

FACILITY NAME: MEDING'S HOME CARE III
FACILITY NUMBER: 198600462

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/02/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
80088(e)(1)
Fixtures, Furniture, Equipment, and Supplies
(e) Faucets used by clients for personal care such as shaving and grooming shall deliver hot water. (1) Hot water temperature controls shall be maintained to automatically regulate temperature of hot water delivered to plumbing fixtures used by clients to attain a hot water temperature of not less than 105 degrees F (40.5 degrees C) and not more than 120 degrees F (48.8 degrees C).

This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on [(observation) (interview)], the licensee did not comply with the section cited above in [(objects)] [identifiers] which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 08/04/2023
Plan of Correction
1
2
3
4
The admininstrator adjusted the hot water temperature between 118.5F and 119.3F. The administrator will create a plan to ensure future compliance. The administrator will submit the pln of correction to LPA via email. Antonine.Richard@dss.ca.gov
Section Cited
Deficient Practice Statement
1
2
3
4
POC Due Date:
Plan of Correction
1
2
3
4
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Ulysses Coronel
LICENSING EVALUATOR NAME:Antonine Richard
LICENSING EVALUATOR SIGNATURE:
DATE: 08/02/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/02/2023


LIC809 (FAS) - (06/04)
Page: 3 of 3