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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198601378
Report Date: 06/16/2023
Date Signed: 06/16/2023 03:05:17 PM

Document Has Been Signed on 06/16/2023 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
GREATER LA AC/SC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754
FACILITY NAME:CHOIX VOCATIONAL SERVICESFACILITY NUMBER:
198601378
ADMINISTRATOR:MARIA ZAMBRANOFACILITY TYPE:
775
ADDRESS:204 S.ATLANTIC BLVD STE #1,2,4TELEPHONE:
(323) 727-5033
CITY:LOS ANGELESSTATE: CAZIP CODE:
90022
CAPACITY: 60CENSUS: 10DATE:
06/16/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:24 AM
MET WITH:Maria Zambrano, AdministratorTIME COMPLETED:
03:13 PM
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Licensing Program Analyst (LPA) Alberto Lopez conducted an unannounced annual inspection at the facility. Upon arrival, LPA met with Maria Zambrano (Administrator) and explained the purpose of the visit. The facility is licensed to serve 60 developmentally disabled adults. Five (5) can be non-ambulatory. Hours of operation M-F 8am to 5pm.

LPA use the CARE tool for this visit.

LPA observed the following:

Infection Control: The facility staff are using appropriate hand hygiene. Disposals of trash are done immediately. Staff are still cleaning and disinfecting throughout the day. Facility has sufficient PPE supplies and has an Infection Control Plan posted by the entrance.
Physical Plant & Environment Safety: The 2-story facility is in good repair and there are no obstructions. Fire and carbon monoxide detectors are in every room and were operational. Three bottles of cleaning solutions were accessible to clients and administrator secured them right away. Fire extinguishers are located at facility and serviced. The water temperature measured between 116.7 -117.5 which is within regulatory range.

Continued on (809D)
SUPERVISORS NAME: Lisa Hicks
LICENSING EVALUATOR NAME: Alberto Lopez
LICENSING EVALUATOR SIGNATURE: DATE: 06/16/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/16/2023
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
GREATER LA AC/SC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754
FACILITY NAME: CHOIX VOCATIONAL SERVICES
FACILITY NUMBER: 198601378
VISIT DATE: 06/16/2023
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Operational Requirements: The facility has plan to accept clients with developmental disabilities. The facility has enough liability insurance covering injury to residents and guest.
The 2-story facility consist of the following: 1st floor: 2 garages, 1 kitchen/garage, 2 activity rooms, quiet room, 2 bathrooms, 2 closets, 2 multipurpose rooms and a storage room. 2nd floor: 5 offices, 2 multipurpose rooms, lobby, reception area, 3 bathrooms. supply room, closet, kitchen, computer room and an office equipment area.
Staffing: There appears to be sufficient staffing at the facility. The administrator’s Maria Zambrano certificate expires 12/11/2023. Staff employed are all over the age of 18.
Personnel Records-Training: Staff files are maintained at the facility. Staff have current evidence of on-going training.
Client Records-Incident Reports: Resident files are maintained at the facility and have the following documents in their files - Admission Agreements, face sheet and other required documentation. Several clients did not have current IPP in files.
Client Rights-Information: The Complaint poster and personal rights are posted by the main entry.
Food Service: No food is served or stored at facility.
Health-Related Services: Staff have current CPR/first aid training
Incidental Medical Services: No medications are stored or administered at facility
Disaster Preparedness: The facility has an Emergency Disaster Plan posted with contact numbers and at least 2 relocation sites.
Emergency Intervention: NA

During the visit today, LPA observed deficiencies and are indicated on the LIC809D.

Deficiency sited (See 809D) and technical advisory was also provided. An exit interview was held. A copy of this report, LIC809D, technical advisory notes, and appeal rights were given to Staff Maria Zambrano

SUPERVISORS NAME: Lisa Hicks
LICENSING EVALUATOR NAME: Alberto Lopez
LICENSING EVALUATOR SIGNATURE:

DATE: 06/16/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/16/2023
LIC809 (FAS) - (06/04)
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