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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198601429
Report Date: 01/11/2022
Date Signed: 01/11/2022 01:21:36 PM

Document Has Been Signed on 01/11/2022 01:21 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
CCLD Regional Office, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754
FACILITY NAME:CHOICES R US - WARDFACILITY NUMBER:
198601429
ADMINISTRATOR:GILBERT CARDENASFACILITY TYPE:
735
ADDRESS:2100 WARD AVETELEPHONE:
(562) 445-3009
CITY:COMPTONSTATE: CAZIP CODE:
90221
CAPACITY: 3CENSUS: 3DATE:
01/11/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:04 AM
MET WITH:Marc SweetTIME COMPLETED:
01:35 PM
NARRATIVE
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Licensing Program Analyst (LPA) Ulysses Coronel conducted an unannounced Annual required visit with a primary focus on infection control measures. LPA was met by staff Isaac Samuel and spoke to administrator Marc Sweet via telephone and the purpose of today’s visit was explained. The facility is licensed to serve 3 developmentally disabled clients of which 1 may be non-ambulatory.

There are currently 3 South Central Los Angeles Regional Center clients in placement. 1 out of 3 clients is non-ambulatory. The facility is a single story structure located in a residential neighborhood. It consists of the following: living room, kitchen, dining room, three (3) resident bedrooms, one and a half (1 1/2) bathrooms with a two car attached garage and patio with chairs.

LPA and staff toured the physical plant. There are no bodies of water or firearm/ammunition on the premises. All client rooms were checked. Beds and bedding were in good condition, adequate lighting provided, storage for client 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. A comfortable temperature is maintained in the facility. LPA observed the facility to be clean and appropriately furnished at the time of visit. Storage areas for personal hygiene, cleaning agents, toxins, and sharps were inaccessible to clients. The kitchen was inspected and there is enough perishable and non-perishable food available which is stored properly. Fire extinguisher was charged, smoke detectors and Carbon Monoxide were operable.

During the visit, LPA observed the facility infection control practices. LPA observed screening protocols for visitors, staff and residents, sanitizing stations ( Located in common areas and restrooms). LPA observed staff and residents were wearing face coverings, an isolation room and required postings throughout the facility. The facility has a 30-day supply of Personal Protective Equipment (PPE).
SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Ulysses Coronel
LICENSING EVALUATOR SIGNATURE: DATE: 01/11/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/11/2022
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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Document Has Been Signed on 01/11/2022 01:21 PM - It Cannot Be Edited


Created By: Ulysses Coronel On 01/11/2022 at 12:04 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754

FACILITY NAME: CHOICES R US - WARD
FACILITY NUMBER: 198601429

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/11/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
80087(a)
Building and Grounds
(a) The facility shall be clean, safe, sanitary and in good repair at all times for the safety and well-being of clients, employees and visitors.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation and interview, the licensee did not comply with the section cited above, the floor in the living room and in bedroom #3 have warped and are missing some planks, the door in bedroom #1 is in disrepair and the headboard to the bed in bedroom #2 is in disrepair, which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 01/31/2022
Plan of Correction
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The administrator agreed to have the said items repaired and submit a plan to ensure that the facilit is in good repair at all times. Proof of correction will be submitted by the POC due date.
Type B
Section Cited
CCR
80087(c)
Building and Grounds
(c) All outdoor and indoor passageways, stairways, inclines, ramps, open porches and other areas of potential hazard shall be kept free of obstruction.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation and interview, the licensee did not comply with the section cited above the side walkway from the backyard to the front yard is obstructed by multiple black garbage bags filled with recyclables and 4 used SUV tires, which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 01/18/2022
Plan of Correction
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The administrator agreed to remove the said obstructions and create a plan to ensure that all passageways will be kept free of obstructions. Proof of correction will be submitted by the POC due date.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Janae Hammond
LICENSING EVALUATOR NAME:Ulysses Coronel
LICENSING EVALUATOR SIGNATURE:
DATE: 01/11/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/11/2022


LIC809 (FAS) - (06/04)
Page: 2 of 10
Document Has Been Signed on 01/11/2022 01:21 PM - It Cannot Be Edited


Created By: Ulysses Coronel On 01/11/2022 at 12:04 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754

FACILITY NAME: CHOICES R US - WARD
FACILITY NUMBER: 198601429

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/11/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
80087(g)
Building and Grounds
(g) Disinfectants, cleaning solutions, poisons, firearms and other items that could pose a danger if readily available to clients shall be stored where inaccessible to clients.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation and interviews, the licensee did not comply with the section cited above 16 bottles filled with disinfectants and cleaning solutions were present on the bedroom floor in bedroom #1. which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 01/18/2022
Plan of Correction
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The administrator agreed to store said cleaning solutions and disinfectants where inaccessible to clients and create a plan that ensures that disinfectants, cleaning solutions, poisons, firearms and other items that could pose a danger if readily available to clients shall be stored where inaccessible to clients. Proof of correction shall be submitted by POC due date.
Type B
Section Cited
CCR
80088(e)(1)
Fixtures, Furniture, Equipment, and Supplies
(e) Faucets used by clients for personal care such as shaving and grooming shall deliver hot water. (1) Hot water temperature controls shall be maintained to automatically regulate temperature of hot water delivered to plumbing fixtures used by clients to attain a hot water temperature of not less than 105 degrees F (40.5 degrees C) and not more than 120 degrees F (48.8 degrees C).

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, the licensee did not comply with the section cited above the hot water temperature tested at 98.8 degrees Fwhich poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 01/18/2022
Plan of Correction
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The administrator agreedd to have the hot water temperature adjusted and will create a plan ensuring that Hot water temperature controls shall be maintained to automatically regulate temperature of hot water delivered to plumbing fixtures used by clients to attain a hot water temperature of not less than 105 degrees F (40.5 degrees C) and not more than 120 degrees F (48.8 degrees C. Proof of corrections will be submitted by the POC due date.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Janae Hammond
LICENSING EVALUATOR NAME:Ulysses Coronel
LICENSING EVALUATOR SIGNATURE:
DATE: 01/11/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/11/2022


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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: CHOICES R US - WARD
FACILITY NUMBER: 198601429
VISIT DATE: 01/11/2022
NARRATIVE
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LPA advised the Administrator to continuously monitor the Centers for Disease Control (CDC) website and Community Care Licensing Provider Informational Notices (PIN) for any updates relating to COVID-19 guidance.

The following deficiencies were observed during today’s visit: 1.) LPA observed that the floor in the living room and in bedroom #3 have warped and are missing some planks. LPA observed that the door in bedroom #1 is in disrepair. LPA observed that the headboard to the bed in bedroom #2 is in disrepair. 2.) LPA observed that the side walkway from the backyard to the front yard is obstructed by multiple black garbage bags filled with recyclables and 4 used SUV tires. 3.) LPA observed multiple bottles filled with disinfectants and cleaning solutions on the bedroom floor in bedroom #1. 4.) LPA measured the hot water temperature and it tested at 98.8 degrees F. 5.) A report was not submitted to CCL regarding a staff testing positive for COVID-19 on 12/25/2021. California Code of Regulations, Title 22, Division 6 and Chapter 1 and 6 are being cited on the attached LIC809D.

Exit interview held. A copy of the report and appeals rights were provided to staff Isaac Samuel and administrator Marc Sweet.
SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Ulysses Coronel
LICENSING EVALUATOR SIGNATURE:

DATE: 01/11/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/11/2022
LIC809 (FAS) - (06/04)
Page: 9 of 10
Document Has Been Signed on 01/11/2022 01:21 PM - It Cannot Be Edited


Created By: Ulysses Coronel On 01/11/2022 at 12:20 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754

FACILITY NAME: CHOICES R US - WARD
FACILITY NUMBER: 198601429

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/11/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
80061(b)(1)(E)
Reporting Requirements
Upon the occurrence, during the operation of the facility, of any of the events specified in (1) below, a report shall be made to the licensing agency within the agency's next working day during its normal business hours. In addition, a written report containing the information specified in (2) below shall be submitted to the licensing agency within seven days following the occurrence of such event. Events reported shall include the following: Any unusual incident or client absence which threatens the physical or emotional health or safety of any client.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on interview and record review the licensee did not comply with the section cited above in a report was not submitted to CCL regarding a staff testing positive to COVID-19 on 12/25/2021, which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 01/18/2022
Plan of Correction
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The administrator agreed to create a plan that to ensure that any unusual incident which threatens the health or safety of any client are reported to the agency within the agency's next working day during its normal business hours. In addition, a written report containing the information specified in (2) below shall be submitted to the licensing agency within seven days following the occurrence. Proof of correction will be submitted by POC due date.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Janae Hammond
LICENSING EVALUATOR NAME:Ulysses Coronel
LICENSING EVALUATOR SIGNATURE:
DATE: 01/11/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/11/2022


LIC809 (FAS) - (06/04)
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