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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198601465
Report Date: 10/08/2022
Date Signed: 10/08/2022 12:12:50 PM

Document Has Been Signed on 10/08/2022 12:12 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:GUIDING HANDS RESIDENTIAL CARE IIFACILITY NUMBER:
198601465
ADMINISTRATOR:TERESA MCDOWELLFACILITY TYPE:
735
ADDRESS:1307 W. 41ST STREETTELEPHONE:
(323) 903-5694
CITY:LOS ANGELESSTATE: CAZIP CODE:
90037
CAPACITY: 6CENSUS: 4DATE:
10/08/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
08:25 AM
MET WITH:Troy Banner HatcherTIME COMPLETED:
12:15 PM
NARRATIVE
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On 10/08/22, Licensing Program Analyst (LPA) Ernand Dabuet conducted an unannounced annual required visit with a primary focus on Infection Control measures using the CARE Inspection Tool. LPA met with the caregiver Elery Mc Allister. Mac Allister contacted administrator Theresa Mc Dowell and explained the purpose of today’s visit. McDowell was unable to join the visit and sent facility manager Troy Banner. The facility is licensed to operate for six (6) ambulatory developmentally disabled adults ages 18 through 59 years. The clients are South Central Los Angeles Regional Center consumers.

The facility is a two-story structure located in a residential neighborhood. It consists of the following: four (4) client's rooms, two (2) common bathrooms, one (1) staff bedroom, a living area, a dining area, a kitchen, an office, a laundry room, and an outside patio area.

LPA toured the physical plant. There were no bodies of water or obstructions on the premises. All rooms were inspected. Beds and bedding supplies were in adequate condition, lighting was provided, and storage for the client's personal belongings was observed. Bed linens, comforters, and bath towels were stocked during the visit. The bathrooms were in operational condition. A comfortable temperature of 73 degrees was maintained in the facility.

LPA observed the facility to be furnished at the time of the visit. Storage areas for personal hygiene were stored and not accessible to clients. The kitchen was inspected, and sufficient perishable and non-perishable food was maintained adequately. Fire extinguishers were all fully charged, and smoke detectors and carbon monoxide were operable. The facility maintains a Certificate of Liability Insurance effective 01/23/22 – 01/23/23. A review of Medication Administration Records was maintained in order and accurate. The facility has several landline telephones on-site in working condition.

Evaluation Report Continues on LIC 809-C
SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Ernand Dabuet
LICENSING EVALUATOR SIGNATURE: DATE: 10/08/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/08/2022
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 10/08/2022 12:12 PM - It Cannot Be Edited


Created By: Ernand Dabuet On 10/08/2022 at 11:09 AM
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: GUIDING HANDS RESIDENTIAL CARE II
FACILITY NUMBER: 198601465

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/08/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
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, the licensee did not comply with the section cited above. LPA identified cleaning solutions and knives in an unlocked cabinets in kitchen and and all purpose room. This violation which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 10/09/2022
Plan of Correction
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The licensee will adhere to regulations 80087 and remove and to store all hazardous items in a locked storage compartment at all times. The licensee will send proof of correction by POC 10/09/22.
*This violation is corrected during visit.*
Type A
Section Cited
CCR
80088(e)(2)
Fixtures, Furniture, Equipment, and Supplies
(e) Faucets used by clients for personal care such as shaving and grooming shall deliver hot water. (2) Taps delivering water at 125 degrees F (51.6 degrees C) or above shall be prominently identified by warning signs.

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. At 10:59am LPA identified the water temperature in bathroom #1 at 143.1 F. This violation which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 10/09/2022
Plan of Correction
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The licensee will adhere to regulations 80088 and adjust the water temperature to reflect 105-120 F. The licensee will send proof of correction by POC 10/09/22.
*This violation is corrected during visit.*
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:Ernand Dabuet
LICENSING EVALUATOR SIGNATURE:
DATE: 10/08/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/08/2022


LIC809 (FAS) - (06/04)
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Document Has Been Signed on 10/08/2022 12:12 PM - It Cannot Be Edited


Created By: Ernand Dabuet On 10/08/2022 at 11:10 AM
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: GUIDING HANDS RESIDENTIAL CARE II
FACILITY NUMBER: 198601465

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/08/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
80088(e)(3)
Fixtures, Furniture, Equipment, and Supplies
(e) Faucets used by clients for personal care such as shaving and grooming shall deliver hot water. (3) All toilets, handwashing and bathing facilities shall be maintained in safe and sanitary operating condition. Additional equipment, aids, and/or conveniences shall be provided in facilities accommodating physically handicapped clients who need such items.

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. LPA identified bathroom #2 washbasin and shower floor require deep cleaning. This violation which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 10/22/2022
Plan of Correction
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The licensee will adhere to regulations 80088 ensure to perofrmed deep cleaning of all surfaces in bathroom #2 . The licensee will send proof of correction by POC 10/22/22
Type B
Section Cited
CCR
80076(a)(19)
Food Service
(a) In facilities providing meals to clients, the following shall apply: (19) All equipment, fixed or mobile, dishes, and utensils shall be kept clean and maintained in safe condition.

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. LPA identified (2) stove burners not working properly and requires manual lighting with a match to operate. This is a fire hazard. This violation which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 11/08/2022
Plan of Correction
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The licensee will adhere to regulations 80076 and ensure to repair or replace non-operable burners. The licensee will send proof of correction by POC 11/08/22.
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:Ernand Dabuet
LICENSING EVALUATOR SIGNATURE:
DATE: 10/08/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/08/2022


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: GUIDING HANDS RESIDENTIAL CARE II
FACILITY NUMBER: 198601465
VISIT DATE: 10/08/2022
NARRATIVE
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INFECTION CONTROL:
During the visit, LPA observed the facility's infection control practices. LPA observed screening protocols for visitors, staff, and residents, sanitizing stations in common areas and restrooms. LPA observed staff wearing face coverings, LPA observed the facility has a 30-day supply of Personal Protective Equipment (PPE). All mandated inspection control posters were posted. A review of staff and resident vaccination records. The facility has an approved CCLD Mitigation Plan.

DEFICIENCIES:
During the inspection, LPA identified at 9:50 am cleaning solutions, disinfectants, and knives in an unlocked cabinet. At 10:59 am, LPA tested the water temperature in bathroom #1 at 143.1 F. At 11:11 am, LPA observed the washbasin and shower in bathroom #2 all surfaces require deep cleaning. At 11:20 am, LPA identified (2) stove burners, not in working condition which requires a match to light manually.

Deficiencies are issued and an exit interview is conducted with Troy Banner. A copy of this report is provided along with the appeal rights.


SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Ernand Dabuet
LICENSING EVALUATOR SIGNATURE:

DATE: 10/08/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/08/2022
LIC809 (FAS) - (06/04)
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