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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198601102
Report Date: 09/25/2023
Date Signed: 09/25/2023 05:01:47 PM

Document Has Been Signed on 09/25/2023 05:01 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:S.T.A.R., INC.FACILITY NUMBER:
198601102
ADMINISTRATOR:BRODERICK, PAMELAFACILITY TYPE:
735
ADDRESS:4226 WEST 231ST STREETTELEPHONE:
(310) 791-3333
CITY:TORRANCESTATE: CAZIP CODE:
90505
CAPACITY: 6CENSUS: 6DATE:
09/25/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
02:14 PM
MET WITH:Administrator, Laura PalominoTIME COMPLETED:
05:00 PM
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On 09/25/2023 at 2:00 pm Licensing Program Analyst (LPA) David España conducted an unannounced required annual visit. Upon arriving at the facility, LPA met with the Administrator Laura Palomino, who assisted with the visit. Upon arrival at the facility, LPA David España conducted a risk assessment at the front door. Based on the assessment, the facility is not cleared of Covid-19 infection. LPA verified last Thursday Sep. 21, 2023, there was one (1) COVID-19 case.

There are currently six (6) residents in care. Licensed To Serve Six (6) Developmentally Disabled Adults, ages 18-59, Ambulatory Only. The facility is a one-story structure with 6 bedrooms and 3 bathrooms, living room, family room, kitchen and back patio.

LPA and Administrator toured the physical plant. There are no bodies of water or firearm/ammunition on the premises. All client rooms were checked. Beds and bedding were in good condition, adequate lighting provided, storage for client personal belongings was observed. Walls and floors were in good repair. 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. LPA observed the facility to be clean and appropriately furnished at the time of visit. Storage areas for personal hygiene, cleaning agents, toxins, and sharps were inaccessible to clients. The kitchen was inspected and there is a 2-day supply of perishable and a 7-day supply of non-perishable food available, maintained properly. Fire extinguisher (3) was charged, smoke detectors and Carbon Monoxide were operable. Disaster drill was last conducted on 02/22/2023. During the visit, LPA observed the facility infection control practices. LPA observed screening protocols for visitors, staff and residents, sanitizing stations (Located in common areas and restrooms and Room 1). LPA observed staff and residents were wearing face coverings, an isolation room and required postings throughout the facility. LPA observed the facility has a 30-day supply of Personal Protective Equipment (PPE).
SUPERVISORS NAME: Ulysses Coronel
LICENSING EVALUATOR NAME: David Espana
LICENSING EVALUATOR SIGNATURE: DATE: 09/25/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/25/2023
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: S.T.A.R., INC.
FACILITY NUMBER: 198601102
VISIT DATE: 09/25/2023
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LPA advised the Administrator to continuously monitor the Centers for Disease Control (CDC) website and Community Care Likening Provider Informational Notices (PIN) for any updates relating to COVID-19 guidance.

During today’s visit there were no deficiencies observed under California code of regulation title 22, division 6, chapter 8.

No deficiencies cited. Exit interview conducted and a copy of this report was given at the time of visit, Administrator Laura Palomino.

SUPERVISORS NAME: Ulysses Coronel
LICENSING EVALUATOR NAME: David Espana
LICENSING EVALUATOR SIGNATURE:

DATE: 09/25/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/25/2023
LIC809 (FAS) - (06/04)
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