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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198601102
Report Date: 05/05/2024
Date Signed: 05/05/2024 11:49:05 AM

Document Has Been Signed on 05/05/2024 11:49 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
EL SEGUNDO ASC, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245
FACILITY NAME:S.T.A.R., INC.FACILITY NUMBER:
198601102
ADMINISTRATOR/
DIRECTOR:		BRODERICK, PAMELAFACILITY TYPE:
735
ADDRESS:4226 WEST 231ST STREETTELEPHONE:
(310) 791-3333
CITY:TORRANCESTATE: CAZIP CODE:
90505
CAPACITY: 6CENSUS: 5DATE:
05/05/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:07 AM
MET WITH:SHANNON HAMLINGTIME VISIT/
INSPECTION COMPLETED:
12:00 PM
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On 05/05/2024, Licensing Program Analyst (LPA) Antonine Richard conducted an unannounced required annual visit. Upon arriving at the facility, LPA met with the staff, Rachelle Salvador who assisted with the visit. Later LPA was joined by administrator Shannon Hamling.
There are currently five (5) 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 Staff 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. The hot water temperature in the bathrooms tested 114.8F to 118.3F degrees. 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.
SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Antonine Richard
LICENSING EVALUATOR SIGNATURE: DATE: 05/05/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/05/2024
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 ASC, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245
FACILITY NAME: S.T.A.R., INC.
FACILITY NUMBER: 198601102
VISIT DATE: 05/05/2024
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Fire extinguisher (3) was charged, smoke detectors and Carbon Monoxide were operable. Disaster drill was last conducted on 03/13/2024.

During the visit, LPA observed visitors, staff and residents, sanitizing stations (Located in common areas and restrooms and Room 1). LPA observed a 30-day supply of Personal Protective Equipment (PPE).


During today’s visit there were no deficiencies cited.

Exit interview conducted and a copy of this report was given at the time of visit, to Administrator Shannon Hamling

SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Antonine Richard
LICENSING EVALUATOR SIGNATURE:

DATE: 05/05/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/05/2024
LIC809 (FAS) - (06/04)
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