198600462-4-8-2024-11-AS-RCLD-D45Q7L-20240408115519

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 198600462
Report Date: 04/08/2024
Date Signed: 04/08/2024 11:55:33 AM

Document Has Been Signed on 04/08/2024 11:55 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 ASC, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754

FACILITY NAME:	MEDING'S HOME CARE III		FACILITY NUMBER:	198600462
ADMINISTRATOR/ DIRECTOR:	ROGELIO S. ROMERO		FACILITY TYPE:	735
ADDRESS:	1619 WEST 216TH STREET		TELEPHONE:	(310) 830-3286
CITY:	TORRANCE	STATE: CA	ZIP CODE:	90501
CAPACITY: 6		CENSUS: 2	DATE:	04/08/2024
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	08:59 AM
MET WITH:	Rogelio Romero		TIME VISIT/ INSPECTION COMPLETED:	12:05 PM

NARRATIVE

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On 04/08/2024 at 9:00 AM, Licensing Program Analyst (LPA) Regina Cloyd conducted an unannounced Required – 1 Year Inspection to the above-named facility and met with Administrator Rogelio Romero. LPA explained the purpose of the visit and were accompanied by Administrator inside and outside the facility during this inspection.

This facility consists of two (2) client 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.

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. Both clients were at Day Program.

Outside grounds were toured and no bodies of water were observed. Patio furniture under a shaded area was accessible to clients. Walkways around the home were clear of hazards. There are no security bars or weapons on the premises.

2 out of 2 client’s bedrooms were checked. Mattresses were in good condition, adequate lighting, plenty of dresser and closet space observed. Walls and floors were clean and in good condition. Comforters, bed linen, bath towels and mattress protectors were adequately stocked. Bathroom toilets and water faucets worked properly. Adequate lighting and toiletries accessible to clients. LPA Cloyd tested hot water temperature and it measured at 107 degrees Fahrenheit. This facility provides clients with hygiene products such as nonmedicated soap, toilet paper, toothbrush, toothpaste, and comb.

LPA observed supplies of nonperishable foods for a minimum of one week and fresh perishable foods for a minimum of two days.

Continue to LIC809-C

SUPERVISORS NAME: Ulysses Coronel
LICENSING EVALUATOR NAME: Regina Cloyd
LICENSING EVALUATOR SIGNATURE:	DATE: 04/08/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/08/2024

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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754

FACILITY NAME: MEDING'S HOME CARE III	FACILITY NUMBER: 198600462
	VISIT DATE: 04/08/2024

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LPA observed that Medications were safe, locked and inaccessible. All medications observed were labeled and maintained in compliance with label instructions and State and Federal law. Documents are posted as mandated. Last Disaster drill was conducted on 03/07/2024. First aid kit is fully stocked with manual. Smoke and carbon monoxide detectors were in compliance and operational.

Four (4) staff records were reviewed and two (2) staff members were interviewed.

Two (2) client records were reviewed and, 2 out of 2 client records had Admission Agreements, Medical Assessments, Pre-appraisals (or Reappraisals) and/or Needs & Services Plans. Two client medications were reviewed. LPA Cloyd reviewed P&I money, 2 out of 2 clients P&I were intact and were not commingled with facility funds or petty cash.

Deficiencies are being cited based on LPA observation, interviews conducted and record review in accordance with the California Code of Regulations, Title 22, see LIC809D. A violation regarding criminal record transfer request warrants an civil penalty of $500.00 per person and is hereby assessed, see LIC421BG. During record review, LPA Cloyd did not observe staff #2 and staff #3 to be associated with the facility. Both staff members were present during the facility tour.

An exit interview was conducted, Plans of Corrections were developed and reviewed. A copy of this report and appeal rights were discussed and left with the Administrator Rogelio Romero.

SUPERVISORS NAME: Ulysses Coronel
LICENSING EVALUATOR NAME: Regina Cloyd
LICENSING EVALUATOR SIGNATURE:	DATE: 04/08/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/08/2024

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 04/08/2024 11:55 AM - It Cannot Be Edited

Created By: Regina Cloyd On 04/08/2024 at 11:36 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: 04/08/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type A

Section Cited

CCR

80019(e)(3)

(e) All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1522 shall prior to working, residing or volunteering in a licensed facility: (3) Request a transfer of a criminal record clearance as specified in Section 80019(f). This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on record review, the licensee did not comply with the section cited above two out of four staff members which poses an immediate safety risk to persons in care. LPA Cloyd did not observe Staff #2 and Staff #3 to be associated to the facility. Both staff members were present during the facility tour.
	POC Due Date: 04/09/2024
	Plan of Correction
1 2 3 4	The Administrator will submit criminal record transfer request for Staff #2 and #3 by the POC. The Administrator will ensure that all staff are associated to the facility prior to working.

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:

Regina Cloyd

LICENSING EVALUATOR SIGNATURE:

DATE: 04/08/2024

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/08/2024

LIC809 (FAS) - (06/04)

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