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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198600781
Report Date: 03/27/2023
Date Signed: 03/27/2023 01:26:04 PM

Document Has Been Signed on 03/27/2023 01:26 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
EL SEGUNDO, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754
FACILITY NAME:DELIGHT SOME LANDFACILITY NUMBER:
198600781
ADMINISTRATOR:ALLEN D HAWKINSFACILITY TYPE:
735
ADDRESS:13313 ROSELLE AVENUETELEPHONE:
(310) 644-0420
CITY:HAWTHORNESTATE: CAZIP CODE:
90250
CAPACITY: 4CENSUS: 2DATE:
03/27/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Allen HawkinsTIME COMPLETED:
01:45 PM
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On 03/27/23, Licensing Program Analyst (LPA) Wendy Gibbs conducted an unannounced required annual visit using the CARE Inspection Tools. Upon arrival at the facility, LPA Gibbs met with Administrator, Allen Hawkins and explained the purpose of this visit. The facility is licensed for four (4) ambulatory developmentally disabled clients ages 18-59 years of age. Currently there are 2 residents living in the facility. Residents were not present during the visit, they were at day program.
Structure The facility is a single-story home in a residential neighborhood. It consists of (2) resident bedrooms, (1) bathroom, living room, dining room/ den, kitchen, staff room, office area and an outdoor covered patio, backyard, an attached garage, and 2 storage sheds.
Physical Plant LPA and Administrator toured the facility, inside and out. Outside LPA observed a covered patio with table and chairs for Resident use. The Administrator has a worktable behind the house and 3 locked sheds with work supplies. In the garage is facility storage, cleaning supply, staff and resident files, paper goods and additional PPEs. All walkways were clean, clear, and free of obstructions, hazards, and debris. LPA did not observe any bodies of water on the premises.
Bedroom All rooms were inspected. Bedrooms are private. All rooms have the required furniture including a bed, dressers, nightstand, chair, and storage for personal belongings. Beds and bedding supplies were in good condition. All beds have the required linens including mattress cover, fitted sheets, blankets, comforter and pillows. Resident rooms had adequate lighting.
Bathroom LPA checked the bathroom. LPA observed sufficient liquid soap and paper towels. Toilets, water faucets, and shower worked properly. The grab bars were securely fastened. The shower had nonskid material on the bottom. LPA observed the shower to be free of mold/mildew. The water temperature measured at 115.9-degrees Fahrenheit.
Linens LPA observed and adequate supply of linens and towel in the cupboard in the hallway. Additionally in the hall cupboard is a supply of paper goods and hygiene products.
SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Wendy Gibbs
LICENSING EVALUATOR SIGNATURE: DATE: 03/02/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/02/2023
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
EL SEGUNDO, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754
FACILITY NAME: DELIGHT SOME LAND
FACILITY NUMBER: 198600781
VISIT DATE: 03/27/2023
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Kitchen LPA toured the kitchen area and observed it to be sanitary and clean. LPA observed a three-day supply of perishable and a seven-day supply of non-perishable foods. All food items were observed to be within their original packaging and within their expiration dates. LPA observed an ample supply of cutleries, pots, and pans to be in good repair. All appliances were observed to be fully functioning and in good repair. Knives and sharps are secured in a cabinet in the den. All cleaning supplies are secured under the sink and toxins were kept in the locked garage.
Common Rooms LPA and Administrator toured all common rooms. All rooms have ample seating to accommodate residents and visitors. All hallways and doorways were clean, clear, and free of obstructions and hazards. LPA observed games and activities for residents. LPA observed a fireplace in the den covered by a screen and inaccessible to residents. A comfortable temperature was maintained in the facility.
Safety Interconnected Carbon Monoxide and Smoke Detectors were tested. LPA observed an additional 3 Carbon Monoxide detectors throughout the facility. LPA observed a brand new (with receipt) fully charged fire extinguisher in the kitchen. The last emergency drill was conducted in 01/11/23. LPA observed a working landline telephone. LPA observed a First Aid Kit fully stocked with required item and a manual. LPA observed all required postings in the den and staff office space. LPA was informed there are no firearms or ammunition stored on the premises.
Infection Control During the tour, LPA observed the facility’s infection control practices. LPA observed a sanitizing station at the facility entrance. LPA reviewed the resident and visitor temperature lot. PPE supplies are readily available to staff, and an additional 30-day supply of PPE was observed stored in the garage. Sufficient paper, cleaning, and disinfecting supplies were observed. LPA Observed staff wear a face covering. LPA observed required postings throughout the facility.
Medication All medications were secured in a cabinet in the den and inaccessible to residents. LPA observed medications in their original packaging. LPA reviewed the MARs and matched them to the resident medications.
File Review LPA reviewed all Resident files and found they contained the required documents. LPA reviewed staff file and found they contained the required documents, training, and certification. LPA reviewed Resident’s P&I log. LPA reviewed the Surety bond for $1,000 through S. Philips Surety, and expires on 03/13/24.

No deficiencies were cited.

An exit interview was conducted and a copy of this report was provided to Administrator.

SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Wendy Gibbs
LICENSING EVALUATOR SIGNATURE:

DATE: 03/27/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/27/2023
LIC809 (FAS) - (06/04)
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