198600486-4-13-2023-28-AS-THEA-CQUVJ2-20230413162801

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 198600486
Report Date: 04/13/2023
Date Signed: 04/13/2023 04:28:08 PM

Document Has Been Signed on 04/13/2023 04:28 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 - FAUST		FACILITY NUMBER:	198600486
ADMINISTRATOR:	GILBERT CARDENAS		FACILITY TYPE:	735
ADDRESS:	13019 FAUST AVE		TELEPHONE:	(562) 803-7969
CITY:	DOWNEY	STATE: CA	ZIP CODE:	90242
CAPACITY: 4		CENSUS: 4	DATE:	04/13/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	01:11 PM
MET WITH:	Lam Ly		TIME COMPLETED:	04:40 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) Tena Herrera conducted the required annual inspection. LPA arrived unannounced and met with Lan Ly (Administrator) who assisted with the visit. The facility is licensed to serve developmentally disabled adults ages 18 to 59 years old, ambulatory only. The facility is located in a residential area. A tour of the single-story facility includes: Living room, kitchen, dining area, 4 client bedrooms, 1 1/2 bathrooms and an attached garage/laundry area. LPA utilized the Compliance and Regulatory Enforcement (CARE) tools for the visit today and observed the following: Infection Control: The facility staff are using appropriate hand hygiene and gloves while assisting residents’ medications. Staff are still cleaning and disinfecting throughout the day. Facility has sufficient PPE supplies and has an Infection Control Plan posted by the entrance. Physical Plant & Environment Safety: There are 4 client bedrooms, 1 ½ bathrooms, living room, kitchen, dining area, and an attached garage/laundry area. Main bathroom is undergoing repairs and was inoperable during today’s visit this is the only bathroom with a shower/tub, handyman was able to put toilet and shower in working order before end of visit. ½ bathroom in residents bedroom is operable and clean, LPA did observe multi-purpose cleaner in the restroom in unlocked cabinet. Administrator removed cleaning product and stored it in locked cabinet located in kitchen immediately. Clients’ bedrooms were checked and closet/drawer space to accommodate each client comfortably was available. The backyard is free of debris/hazards and the outdoor and passageways are free of obstruction. There are no security bars or weapons on the premises. Hygiene products are readily available. The hot water temperature was tested in the ½ restroom and measured at 116 degrees F and kitchen sink measured at 115.5 F, these are within the required range of 105-120 degrees. All storage areas for cleaning solutions, toxins, knives, and hazardous items are in a secured cabinet and inaccessible to clients (besides the multipurpose cleaner mentioned above). The last Fire/Emergency Drill was conducted on 3/2023. Smoke detectors and carbon monoxide detectors are operable and in compliance. The fire extinguisher was observed in the kitchen area and is fully charged. (Continued on 809-C)

SUPERVISORS NAME: David Sicairos
LICENSING EVALUATOR NAME: Tena Herrera
LICENSING EVALUATOR SIGNATURE:	DATE: 04/13/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/13/2023

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

Document Has Been Signed on 04/13/2023 04:28 PM - It Cannot Be Edited

Created By: Tena Herrera On 04/13/2023 at 03:52 PM

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 CNTR DR. ST 500
MONTEREY PARK, CA 91754

FACILITY NAME: CHOICES R US - FAUST	FACILITY NUMBER: 198600486
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 04/13/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type A

Section Cited

CCR

80087(g)

Building and Grounds

(g) Disinfectants, cleaning solutions, poisons, firearms and other items that could pose a danger if readily available to clients shall be stored where inaccessible to clients. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation, the licensee did not comply with the section cited above which poses an immediate health, safety or personal rights risk to persons in care. Multipuropse cleaner was observed in 1/2 restroom located in unlocked cabinet under the sink. Adninistrator immediatly removed cleaner and placed in locked cleaning supply cabinet located in kitchen area.
	POC Due Date: 04/14/2023
	Plan of Correction
1 2 3 4	Administrator to ensure that disinfectants and cleaning solutions will be locked and inaccessible to residents. Adninistrator immediatly removed cleaner and placed in locked cleaning supply cabinet located in kitchen area. POC cleared during todays visit.

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:

David Sicairos

LICENSING EVALUATOR NAME:

Tena Herrera

LICENSING EVALUATOR SIGNATURE:

DATE: 04/13/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/13/2023

LIC809 (FAS) - (06/04)

Page: 2 of 3

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 - FAUST	FACILITY NUMBER: 198600486
	VISIT DATE: 04/13/2023

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

Operational Requirements: There are currently 4 ambulatory residents residing at the facility. One is hospitalized at the moment and pending return.
Staffing: There appears to be sufficient staffing at all times in the facility. Administrator Lan Ly certificate expires on 09-29-2024.
Personnel Records-Training: Staff has criminal record clearance.Staff have current CPR/first aid training and sufficient on-going training. Staff designated to administer medication has the proper annual training on file. Staff files are maintained at the facility located in a locked cabinet in the living room.
Resident Rights-Information: Residents personal rights poster is posted in the kitchen and is clearly visible.
Food Service: The kitchen was observed for the ability to prepare and serve food. LPA observed an appropriate food supply of two (2) days of perishables and one week (7 days) of non-perishables.
Emergency Intervention: Residents at this facility do not have restraints nor do they require the use de-escalation techniques.

Per California Code of Regulations, Title 22, and California Health and Safety Code, the deficiencies observed during the visit are documented on 809D.

Due to time restraints LPA will need return at a later date to complete annual inspection.

Exit interview held and a copy of the report along with appeal rights were provided to administrator Lan Ly.

SUPERVISORS NAME: David Sicairos
LICENSING EVALUATOR NAME: Tena Herrera
LICENSING EVALUATOR SIGNATURE:	DATE: 04/13/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/13/2023

LIC809 (FAS) - (06/04)

Page: 3 of 3