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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198601234
Report Date: 05/26/2023
Date Signed: 09/25/2023 08:45:50 AM

Document Has Been Signed on 09/25/2023 08:45 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, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754
FACILITY NAME:CARTER'S & CATO'S ADULT RESIDENTIAL FACILITYFACILITY NUMBER:
198601234
ADMINISTRATOR:ARWILDER CARTERFACILITY TYPE:
735
ADDRESS:902 N TAJAUTA AVETELEPHONE:
(310) 635-8259
CITY:COMPTONSTATE: CAZIP CODE:
90220
CAPACITY: 6CENSUS: DATE:
05/26/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
08:20 AM
MET WITH:Demetra Carter - BentonTIME COMPLETED:
11:00 AM
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On 05/26/23, Licensing Program Analyst (LPA)/ Felisa Shirley conducted an unannounced annual required visit with a primary focus on Infection Control measures using the new CARE Inspection Tool. The LPA met with Demetra Carter-Benton and explained the purpose of today’s visit. Licensed to serve 6 clients ages 18 to 59 years old. Today’s census is 4.

LPA Shirley and Demetra 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: 4 bedroom, 2 bathrooms, family room/dining room, kitchen, living room, shaded area, indoor and outdoor activity area, laundry room and covered driveway.

The LPA and Demetra toured the physical plant. 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. The facility hot water temperature measured 115.2 degrees Fahrenheit. A comfortable temperature of 75 degrees Fahrenheit was maintained in the facility.

LPA observed the facility to be sanitary and appropriately furnished at the time of visit. Storage areas for 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 extinguishers were charged and inspected 4/2023. Smoke detectors and carbon monoxide are operable.

During the visit, LPA the facility has a 60-day supply of Personal Protective Equipment (PPE). All mandated inspection control posters were posted.

No deficiencies were cited during this inspection visit.

An exit interview was conducted and a copy of this report was provided to Demetra.

SUPERVISORS NAME: Stephanie Cifuentes
LICENSING EVALUATOR NAME: Felisa Shirley
LICENSING EVALUATOR SIGNATURE: DATE: 05/26/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/26/2023
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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