198601192-1-23-2023-11-AS-PBUR-CNCRXS-20230123122514

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 198601192
Report Date: 01/13/2023
Date Signed: 01/23/2023 12:25:47 PM

Document Has Been Signed on 01/23/2023 12:25 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:	NEXT STEP II, THE		FACILITY NUMBER:	198601192
ADMINISTRATOR:	TOIYA SMITH		FACILITY TYPE:	735
ADDRESS:	1842 W 65TH STREET		TELEPHONE:	(323) 971-5002
CITY:	LOS ANGELES	STATE: CA	ZIP CODE:	90047
CAPACITY:	4	CENSUS: 4	DATE:	01/13/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	10:00 AM
MET WITH:	Toiya Smith		TIME COMPLETED:	01:00 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	Licensing Program Analyst (LPA) Pamela Bunker conducted an unannounced Required - 1 Year Annual visit. The primary focus is on the Infection Control measures using the new CARE Inspection Tools. Upon arrival at the facility, LPA Bunker called the facility and spoke to Licensee/Administrator Toiya Smith via telephone to conduct a risk assessment. Based on the assessment, the facility is clear of COVID-19 infection. LPA verified that the facility has an approved Mitigation Plan Report. LPA was properly screened for COVID-19 symptoms and temperature was checked. LPA observed a sanitizing station at the facility entrance; visitors log with COVID-19 screening and temperature log, and records of daily COVID-19 screening and temperature checks of residents and staff. PPE supplies are readily available to staff, and an additional over 60-day supply of PPE is stored in the storage closet; sufficient paper, cleaning, and disinfecting supplies were observed. LPA reviewed the facility’s surveillance testing records. The administrator stated staff and clients are fully vaccinated and that there are four (4) South Central Los Angeles Regional clients currently in placement. LPA Bunker and Licensee Ms. Smith toured the entire facility inside and outside grounds. The facility is a single-story family home located in a residential neighborhood. The facility consisted of the following: Living room, kitchen, dining room, two (2) bedrooms, one (1) bathroom, laundry room, patio shaded area, detached two (2) car garage, front and back yard landscape is in good condition at the time of visit. Documents were posted as mandated. During the tour, LPA Bunker observed the facility’s infection control practices. See continued LIC809-C on page #2

SUPERVISOR'S NAME: Stephanie Cifuentes	TELEPHONE: (661) 644-7743
LICENSING EVALUATOR NAME: Pamela Bunker	TELEPHONE: (323) 213-1113
LICENSING EVALUATOR SIGNATURE:	DATE: 01/13/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/13/2023

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
EL SEGUNDO, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754

FACILITY NAME: NEXT STEP II, THE	FACILITY NUMBER: 198601192
	VISIT DATE: 01/13/2023

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

Continued LIC809-C page #2

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. The first aid kit is fully stocked with a manual, hot water temperature of 120 degrees Fahrenheit, a working telephone, smoke and carbon monoxide detectors were in compliance, fire extinguishers are fully charged, records medications will be centrally stored and properly locked in the hallway closet with the current record, ample supply of perishable and nonperishable food, adequate linen supply, fire/emergency drill conducted on January 01, 2023. No firearms on the premises, the client's bedroom windows have no sliding window locks with thumbscrews, all exit doors were in compliance, covered trash cans, and no bodies of water were present. Hazardous items are inaccessible to clients, the yard is free of debris and hazards.

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

There were no deficiencies cited. LPA Bunker provided Ms. Smith with copies of the Facility Evaluation Reports.

Exit interview conducted.

SUPERVISOR'S NAME: Stephanie Cifuentes	TELEPHONE: (661) 644-7743
LICENSING EVALUATOR NAME: Pamela Bunker	TELEPHONE: (323) 213-1113
LICENSING EVALUATOR SIGNATURE:	DATE: 01/13/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/13/2023

LIC809 (FAS) - (06/04)

Page: 2 of 2