198601375-2-13-2023-11-AS-WGIS-CNPSCQ-20230203124554

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 198601375
Report Date: 02/03/2023
Date Signed: 02/13/2023 03:05:50 PM

Document Has Been Signed on 02/13/2023 03:05 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:	CATO Q CARE ARBUTUS		FACILITY NUMBER:	198601375
ADMINISTRATOR:	PAMELA CATO		FACILITY TYPE:	735
ADDRESS:	1354 W. ARBUTUS ST.		TELEPHONE:	(310) 604-0189
CITY:	COMPTON	STATE: CA	ZIP CODE:	90220
CAPACITY:	4	CENSUS: 3	DATE:	02/03/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	09:56 AM
MET WITH:	Pamela Cato		TIME COMPLETED:	12:45 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 Analysts (LPAs) Wendy Gibbs conducted an unannounced Annual required visit with a primary focus on infection control measures. LPA was met by Care Staff, Ja’den Cato and explained the purpose of this visit. Ja’den called Administrator and informed her of my visit, and we were joined by Pamela Cato 10 minutes after arrival. The facility is licensed to serve 4 ambulatory developmentally disabled clients (age 18-59). All clients were present during the visit. Structure The facility is a single-story structure located in a residential neighborhood. It consists of the following: 2 resident bedrooms, 1 bathroom, TV room, dining room, kitchen, living room, shaded area, indoor and outdoor activity area, laundry room and garage. Physical Plant LPA and Administrator toured the physical plant inside and out. The front and back are landscaped and well maintained. LPA observed a shaded patio with a table and chairs to accommodate all residents and guests. All walkways are clean and clear, free of obstructions, hazards, and debris. There are no bodies of water on the premises. All gates are easily opened from the inside. Bedroom LPA and Administrator toured all resident rooms. LPA observed two (2) beds in both rooms that had mattress that were in good repair. All the beds had the required linens including mattress pad, fitted sheets, blankets, comforter and pillows. All the rooms had a nightstand, closet space that had drawers and shelves for the residents use and space to hang belongings. Both rooms have ample lighting. Bathroom LPA and Administrator toured the bathroom and found it to be within Title 22 regulations. The bathroom was clean and operational. The bathroom had ample lighting. LPA observed a nonskid mat in the shower and secured safety rails. The shower was free of mildew or mold. The water temperature measured 107.1-degrees Fahrenheit. Linens & Hygiene LPA observed an ample supply of linens in the hall closet and cupboard, including sheets, blankets, and towels. There was an ample supply of diapers, and chuck pads for resident stored in the hall cupboard, storage room, and in the garage. LPA observed resident’s toiletries stored in a box in the hall closet, and additional supply of toiletries stored in the storage room.

SUPERVISOR'S NAME: Eva M Alvarez	TELEPHONE: (323) 629-7047
LICENSING EVALUATOR NAME: Wendy Gibbs	TELEPHONE: (323) 981-1755
LICENSING EVALUATOR SIGNATURE:	DATE: 02/03/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/03/2023

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: CATO Q CARE ARBUTUS	FACILITY NUMBER: 198601375
	VISIT DATE: 02/03/2023

NARRATIVE

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Kitchen LPA and Administrator toured the kitchen and found it to be within Title 22 regulations. All appliances were in good working repair. It was clean and free of debris. LPA observed all cutleries, pots, and pans to be in good condition. LPA observed a 3-day supply of perishable foods and a 7-day supply of nonperishable foods. An additional supply of food is stored in the storage room. All sharps were locked in a cabinet and are inaccessible to residents. The water temperature measured 108.3-degrees Fahrenheit.
Common Rooms LPA and Administrator toured the T.V. room, living room and dining room. LPA observed an ample seating to accommodate all residents. LPA observed games and activities for residents in a cabinet in the T.V room. A comfortable temperature was maintained in the facility. LPA observed the facility to be clean and appropriately furnished at the time of visit. All walkways were clean, clear and free of obstructions, and hazards.
Safety LPA observed a Fire extinguisher mounted in the laundry room, next to the kitchen, that is fully charged and last serviced on 07/20/22. LPA tested all smoke detectors and found them to be operational. There is a Carbon Monoxide detector in the hallway that was operable. Last emergency drill was on 01/06/23. LPA observed all required posting in the facility. LPA tested the working landline. LPA went through the First Aid Kit and found it contained the required item and an ample number of supplies and the manual. LPA was informed no firearms or ammunition are stored on the premises.
Infection Control During the visit, LPA observed the facility infection control practices. LPA observed screening protocols for visitors, staff and residents. LPA observed a sanitizing station and log at the entrance and additional sanitizing stations throughout the facility. LPA observed required postings throughout the facility. LPA observed the facility has a 30-day supply of Personal Protective Equipment (PPE) stored in the hall closet and storage room.
Medication LPA reviewed medication for all residents and matched them to the MARs. All medications are stored in a locked cabinet in the kitchen and are inaccessible to residents.
Files LPA reviewed all resident files and found they contained the required documentation. LPA reviewed 3 staff files and found they contained the required documentation, certification and training.

During today’s visit there were no deficiencies observed.

Exit interview held. A copy of the report was provided to Pamela Cato, Administrator.

SUPERVISOR'S NAME: Eva M Alvarez	TELEPHONE: (323) 629-7047
LICENSING EVALUATOR NAME: Wendy Gibbs	TELEPHONE: (323) 981-1755
LICENSING EVALUATOR SIGNATURE:	DATE: 02/03/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/03/2023

LIC809 (FAS) - (06/04)

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