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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198600486
Report Date: 04/18/2023
Date Signed: 04/18/2023 03:05:08 PM

Document Has Been Signed on 04/18/2023 03:05 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 - FAUSTFACILITY NUMBER:
198600486
ADMINISTRATOR:GILBERT CARDENASFACILITY TYPE:
735
ADDRESS:13019 FAUST AVETELEPHONE:
(562) 803-7969
CITY:DOWNEYSTATE: CAZIP CODE:
90242
CAPACITY: 4CENSUS: 4DATE:
04/18/2023
TYPE OF VISIT:Case Management - Annual ContinuationUNANNOUNCEDTIME BEGAN:
01:04 PM
MET WITH:Lam LyTIME COMPLETED:
03:15 PM
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Licensing Program Analyst (LPA) Tena Herrera conducted the required annual continuation inspection. LPA arrived unannounced and met with Lan Ly (Administrator) who assisted with the visit. The purpose for the visit was explained.

The facility is licensed to serve developmentally disabled adults ages 18 to 59 years old, ambulatory only.


LPA inspected the remaining four domains using the Compliance and Regulatory Enforcement (CARE) tools for which include the following:
Records-Incident Reports, Health Related Service, Incidental Medical & Dental and Disaster Preparedness.
Resident Records-Incident Reports: Resident files are kept locked in a closet located near the entrance and has the following documents in their files - Admission Agreements, Identification & Emergency Information, current Physician's Report, Pre-admission appraisal/Appraisal Needs & Services Plan.
Health Related Service: Staff designated to administer medication has the proper annual training on file. Medication is properly labeled and are centrally stored in a locked closet and are in their original containers. During the visit today, LPA reviewed all 3 residents' medication (the 4th resident is currently in hospice) no issues were observed.
Incidental Medical & Dental: All medications for clients are kept locked in a closet near front door entrance and inaccessible to other clients.
Disaster Preparedness: The facility has an Emergency Disaster Plan posted with contact numbers and at least 2 relocation sites.

Today, LPA also interviewed 2 residents, 1 resident was away at day program, and the other is currently in hospice.
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 to administrator Lan Ly.

SUPERVISORS NAME: David Sicairos
LICENSING EVALUATOR NAME: Tena Herrera
LICENSING EVALUATOR SIGNATURE: DATE: 04/18/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/18/2023
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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