198601460-2-8-2024-11-AS-EGOZ-D29UM7-20240208144151

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 198601460
Report Date: 02/08/2024
Date Signed: 02/08/2024 02:41:57 PM

Document Has Been Signed on 02/08/2024 02:41 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 ASC, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245

FACILITY NAME:	ALPHA OMEGA		FACILITY NUMBER:	198601460
ADMINISTRATOR:	HARRIS, YAOUNDE		FACILITY TYPE:	735
ADDRESS:	1911 W 41ST ST		TELEPHONE:	(323) 815-1134
CITY:	LOS ANGELES	STATE: CA	ZIP CODE:	90062
CAPACITY:	4	CENSUS: 3	DATE:	02/08/2024
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	11:36 AM
MET WITH:	Yaounde Harris		TIME COMPLETED:	02:50 PM

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On 2/8/24 Licensing Program Analyst (LPA) Elvira Gonzalez conducted an unannounced Annual required visit using the CARE Tool. LPA met with Yaounde Harris, Licensee and the purpose of today’s visit was explained. LPA was granted access to the facility. Facility is licensed to serve four (4) clients between the ages of 18 and 59 years old, ambulatory only. There are currently three (3) clients in the facility.

The facility consists of a single-story home in a residential neighborhood. The facility consists of three (3) bedrooms, two (2) bathrooms, a living room, kitchen, laundry room, and an attached garage. The front of the house has a shaded porch with two (2) chairs, and the back yard has chairs as well.
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LPA Gonzalez and Licensee Yaounde Harris toured the inside and outside grounds of the facility. Resident bedrooms had the required furniture, bed linens and closet/drawer space to accommodate each resident comfortably. Client bathrooms were checked. Toilets and water faucets worked properly, shower was free of mold/mildew and non-skid mats were in place. The water temperature measured between 105.0 F and 120.0 F in both bathrooms. LPA observed linens, bath towels, toiletries and personal hygiene supplies were adequately stocked. Common areas were clean and clear of hazards; doorways were free of obstructions. There is a fireplace in the living room that is not used. A comfortable temperature was maintained in the facility. LPA observed an ample supply of linens and cleaning supplies secured in a closet in the hallway between bedroom #1 and bedroom #2.

The kitchen was checked and observed to be within Title 22 regulations. Sufficient perishable and non-perishable food supply was maintained adequately. All sharps, toxins, cleaning solutions, hazardous items, and medications were securely locked and inaccessible to residents. A review of Medication Administration Records was maintained in order and accurate.

Continued on LIC 809-C

SUPERVISOR'S NAME: Stephanie Cifuentes	TELEPHONE: (323) 981-1755
LICENSING EVALUATOR NAME: Elvira Gonzalez	TELEPHONE: 323-981-1755
LICENSING EVALUATOR SIGNATURE:	DATE: 02/08/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/08/2024

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 ASC, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245

FACILITY NAME: ALPHA OMEGA	FACILITY NUMBER: 198601460
	VISIT DATE: 02/08/2024

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The facility has a landline telephone on-site in working condition. Medications were centrally stored and properly locked. Smoke detectors and carbon monoxide detectors were operational and working properly. LPA observed a fully charged fire extinguisher next to the kitchen door. LPA observed a stocked First Aid kit along with manual. Outside grounds were toured and no bodies of water were observed. Walkways around the home were clear of hazards.

During the visit, LPA observed the facility's infection control practices. LPA observed screening protocols for visitors, staff, and residents. There are sanitizing stations in common areas and restrooms. LPA observed the facility has a 30-day supply of Personal Protective Equipment (PPE). All mandated inspection control posters were posted. The facility has an approved CCLD Mitigation Plan.

During this inspection LPA did not observe any deficiencies, therefore no citations were issued at this time.

An exit interview was conducted, and a copy of the Report and Appeal Rights was provided to Yaounde Harris, Licensee.

SUPERVISOR'S NAME: Stephanie Cifuentes	TELEPHONE: (323) 981-1755
LICENSING EVALUATOR NAME: Elvira Gonzalez	TELEPHONE: 323-981-1755
LICENSING EVALUATOR SIGNATURE:	DATE: 02/08/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/08/2024

LIC809 (FAS) - (06/04)

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