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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198601003
Report Date: 07/22/2022
Date Signed: 07/22/2022 12:18:07 PM

Document Has Been Signed on 07/22/2022 12:18 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
CCLD Regional Office, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754
FACILITY NAME:ECF, ERAS HOUSE 2FACILITY NUMBER:
198601003
ADMINISTRATOR:DAN R. BOYLEFACILITY TYPE:
735
ADDRESS:4215 KEYSTONE AVENUETELEPHONE:
(310) 838-1109
CITY:CULVER CITYSTATE: CAZIP CODE:
90230
CAPACITY: 6CENSUS: 4DATE:
07/22/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:13 AM
MET WITH:Cecelia MontesTIME COMPLETED:
12:40 PM
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On 07/22/22 at 9:15 AM, Licensing Program Analysts (LPA) Gail Johnson conducted an unannounced annual required visit with a primary focus on Infection Control measures using the CARE Inspection Tool. LPA Johnson was greeted by House Manager Nicole Porter. Administrator Celia Montes arrived approximately 30 minutes later. LPA Johnson explained the purpose of today’s visit. The facility is licensed to operate and care for six (6) developmentally disabled adults ages (18 through 59 / ambulatory only). Currently, four (4) clients reside at this facility.

Facility Structure / Physical Plant The facility is a two-story home located in a residential neighborhood. LPA Johnson toured the physical plant. There were no bodies of water or obstructions on the premises. Bed linens, comforters, and bath towels were adequately stocked at the time of visit. Bathrooms were found to be within Title 22 regulations and were clean and operational. The water temperature measured 111.7 degrees Fahrenheit. It consists of the following: six (6) bedrooms, four (4) bathrooms, living area, dining area, kitchen, outdoor table in a shaded covered space with four (4) chairs.

Bedrooms (Client rooms) Presently, on the first floor, each of the four (4) clients reside in their own private room. All rooms were inspected. Beds and bedding supplies were in good condition, adequate lighting was provided. Storage for client personal belongings was observed.

Storage & Inaccessible Items
Storage areas for personal hygiene, medications, toxins and sharp objects were stored, locked and not accessible to clients. The kitchen was inspected and there is sufficient perishable and non-perishable food available and maintained properly. Smoke detectors and carbon monoxide detectors were operable.

Continued on LIC 809-C
SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Gail Johnson
LICENSING EVALUATOR SIGNATURE: DATE: 07/22/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/22/2022
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
CCLD Regional Office, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754
FACILITY NAME: ECF, ERAS HOUSE 2
FACILITY NUMBER: 198601003
VISIT DATE: 07/22/2022
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Emergency Phone Numbers, Exit Plan, Menu, Records: Emergency numbers are posted and readily available for review. Four (4) fire extinguishers were located in the following areas: one (1) in the kitchen, one (1) in the hallway, one (1) in the living room area, (1) in the upstairs hallway. Facility conducted the last fire drill 07/11/22. The living room and kitchen both have one (1) land-line telephone in each area. LPA reviewed LIS to verify annual fees are current. LPA Johnson reviewed the facilities profile, personnel summary report, medical records, medications, and staff records.

Infection Control
During the visit, LPA Johnson observed the facility's infection control practices. LPA observed screening protocols for visitors, staff, and residents, sanitizing stations in common areas and restrooms. LPA Johnson observed staff was wearing face coverings. LPA observed the facility has a 30-day supply of Personal Protective Equipment (PPE). All mandated inspection control posters were posted. A review of staff and resident temperature logs were reviewed. The facility has a Mitigation Plan Report approved by CCLD on file.

Exit Interview
An exit interview was conducted with Celia Montes. Deficiencies were not cited during this required annual inspection visit. A copy of this report was printed and provided to Celia Montes.

End of report

SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Gail Johnson
LICENSING EVALUATOR SIGNATURE:

DATE: 07/22/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/22/2022
LIC809 (FAS) - (06/04)
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