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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198600824
Report Date: 03/01/2022
Date Signed: 03/04/2022 08:29:32 AM

Document Has Been Signed on 03/04/2022 08:29 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
CCLD Regional Office, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754
FACILITY NAME:WCAY IIFACILITY NUMBER:
198600824
ADMINISTRATOR:LAWRENCE PHILLIPSFACILITY TYPE:
735
ADDRESS:1337 CENTINELA AVETELEPHONE:
(323) 815-9881
CITY:INGLEWOODSTATE: CAZIP CODE:
90302
CAPACITY: 3CENSUS: 3DATE:
03/01/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:20 AM
MET WITH:Larry PhillipsTIME COMPLETED:
02:00 PM
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Licensing Program Analyst (LPA) Pamela Bunker conducted an unannounced required 1- year visit with the primary focus on Infection Control measures and using the new CARE Inspection Tool. Upon arrival at the facility, LPA Bunker conducted a risk assessment. Based on the assessment, the facility is clear of COVID-19 infection. LPA was properly screened for COVID-19 symptoms and temperature was checked. LPA Bunker met Administrator Larry Phillips and explained the purpose of today's Annual Inspection. LPA verified that the facility has an approved mitigation plan report. There are currently three (3), Adult Residential Care Facility (ARF) consumers in placement. The facility's annual fees are current.

The following Domain will be observed and reviewed: Infection Control Practices "I will be using this tool and methods that have been developed to improve the efficiency and accuracy of the Department of Social Services' facility inspections."

The facility is a single-story home located in a residential-commercial neighborhood, family room, dining room, kitchen, laundry/office area, and an indoor/ outdoor activity area. A shaded area with outdoor patio furniture, table, and seating chairs. Bedrooms #1-3 are designated as the client's bedrooms.

See continued LIC809-C page 2
SUPERVISORS NAME: Angela J Kendrick
LICENSING EVALUATOR NAME: Pamela Bunker
LICENSING EVALUATOR SIGNATURE: DATE: 03/01/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/01/2022
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 2
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754
FACILITY NAME: WCAY II
FACILITY NUMBER: 198600824
VISIT DATE: 03/01/2022
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Continued LIC 809-C page #2

Documents were posted as mandated on the wall in the family room. The following Title 22 regulated areas were audited and found to be in compliance: Bedrooms contain the required furniture. The client’s bedrooms were inspected for safety, privacy, and comfort. The living areas are clean, bathrooms are clean and operational. First aid kit is fully stocked with manual, hot water temperature 115 degrees Fahrenheit, working telephone, smoke and carbon monoxide detectors were in compliance, fire extinguishers are fully charged, medications were centrally stored and properly locked in the hallway cabinet and records are current, ample supply of perishable and nonperishable food, adequate linen supply, fire/emergency drill conducted on 02/06/2022.

No firearms on the premises, client's bedroom windows have no sliding window locks with thumbscrews, all exit doors were in compliance, covered trash cans. Hazardous items are inaccessible to clients, the yard is free of debris and hazards.

Mr. Phillips states staff was given training on dependent adult and elder abuse reporting.

A certified administrator certificate is current expires 10/22/2022, and HIV/TB certification is also current.

There were no deficiencies cited.



An exit interview was conducted.
SUPERVISORS NAME: Angela J Kendrick
LICENSING EVALUATOR NAME: Pamela Bunker
LICENSING EVALUATOR SIGNATURE:

DATE: 03/01/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/01/2022
LIC809 (FAS) - (06/04)
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