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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198601216
Report Date: 05/15/2022
Date Signed: 05/16/2022 07:56:52 AM

Document Has Been Signed on 05/16/2022 07:56 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:STARCARE RESIDENTIAL LLCFACILITY NUMBER:
198601216
ADMINISTRATOR:FRED FLUKERFACILITY TYPE:
735
ADDRESS:226 S. MATTHISEN ST.TELEPHONE:
(424) 785-8516
CITY:COMPTONSTATE: CAZIP CODE:
90220
CAPACITY: 4CENSUS: 4DATE:
05/15/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:45 PM
MET WITH:Fred FlukerTIME COMPLETED:
03:45 PM
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On 05/15/22, at 1:45 pm, Licensing Program Analyst (LPA)/ Susan Campos conducted an unannounced annual required visit with a primary focus on Infection Control measures using the new CARE Inspection Tool. LPA was allowed entry into the facility by Administrator Fred Fluker. LPA explained to Mr. Fluker the purpose of today’s visit.

Licensed to serve (4) Ambulatory Developmentally Disabled clients ages 18 to 59 years old. This facility is a level 4I home. Vendorized with the South Central Los Angeles Regional Center. The last fire drill was conducted on 3/15/2022. LPA Campos and Mr. Fluker toured the entire facility inside and outside grounds. The facility is a single story residential home located in a residential neighborhood. The home consists of the following: 2 bedrooms, 1 bathroom, dining room, kitchen, living room, laundry area, backyard with (5) umbrellas, tables and chairs, barbecue, and learning center/ activity room and detached garage.

The LPA and Mr. Fluker toured the physical plant. There were no bodies of water or obstructions on the premises. All rooms were inspected. Beds and bedding supplies were in good condition, adequate lighting provided, storage for resident personal belongings was observed. 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 facility hot water temperature measured 106.3 degrees Fahrenheit. A comfortable temperature of 75 degrees Fahrenheit was maintained in the facility. Personal hygiene, cleaning supplies, toxins, and sharps objects were stored and not accessible to residents. The kitchen was inspected and there is sufficient perishable and non-perishable food available and maintained properly. The facility fire extinguisher is charged, and smoke detectors and carbon monoxide are operable. A review of Medication Administration Records (MAR) was observed to be maintained in order and accurate. LPA observed clients P&I records and was found to be in order. The LPA reviewed client and staff files and they were found to be in order.

Evaluation Report Continued on LIC 809-C

SUPERVISORS NAME: Ulysses Coronel
LICENSING EVALUATOR NAME: Susan Campos
LICENSING EVALUATOR SIGNATURE: DATE: 05/15/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/15/2022
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: STARCARE RESIDENTIAL LLC
FACILITY NUMBER: 198601216
VISIT DATE: 05/15/2022
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During the visit, LPA observed the facility's infection control practices. LPA observed screening protocols for visitors, staff, and residents, sanitizing stations in common areas and restrooms. The LPA observed staff were 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.

No deficiencies were cited during this inspection visit.

An exit interview was conducted and a copy of this report was provided to Fred Fluker

SUPERVISORS NAME: Ulysses Coronel
LICENSING EVALUATOR NAME: Susan Campos
LICENSING EVALUATOR SIGNATURE:

DATE: 05/15/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/15/2022
LIC809 (FAS) - (06/04)
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