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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198601513
Report Date: 01/20/2022
Date Signed: 01/20/2022 04:25:03 PM

Document Has Been Signed on 01/20/2022 04:25 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:OPEN ARMS ADULT RESIDENTIAL FACILITY, LLCFACILITY NUMBER:
198601513
ADMINISTRATOR:ROBBIE M. THOMPSONFACILITY TYPE:
735
ADDRESS:229 SOUTH LOCUST AVENUETELEPHONE:
(310) 346-3447
CITY:COMPTONSTATE: CAZIP CODE:
90221
CAPACITY: 4CENSUS: 4DATE:
01/20/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:10 PM
MET WITH:Robbie M. ThompsonTIME COMPLETED:
04:41 PM
NARRATIVE
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Licensing Program Analyst (LPA) Ulysses Coronel and LPA Jeremiah Randle conducted an unannounced Annual required visit with a primary focus on infection control measures. LPA were met by Robbie M. Thompson, Administrator and the purpose of today’s visit was explained. The facility is licensed to serve four developmentally disabled clients ages 18-59. Ambulatory only.

There are currently 4 South Central Los Angeles Regional Center clients in placement. All 4 clients are ambulatory. The facility is a two-story corner home located in a residential neighborhood which consists of a living room, dining area, kitchen, laundry room, 3 bedrooms, 2 bathrooms and an outdoor shaded area. The first floor will be used for clients. The second-floor level will only be used for the facility staff it has a staff office and a staff lounge.

LPAs and staff toured the physical plant. There are no bodies of water or firearm/ammunition present 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. Walls and floors were in good repair. 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 a enough perishable and non-perishable food available which is stored properly. Fire extinguisher was charged, smoke detectors and Carbon Monoxide detectors 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.
SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Ulysses Coronel
LICENSING EVALUATOR SIGNATURE: DATE: 01/20/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/20/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 10
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: OPEN ARMS ADULT RESIDENTIAL FACILITY, LLC
FACILITY NUMBER: 198601513
VISIT DATE: 01/20/2022
NARRATIVE
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LPAs observed staff, an isolation room and required postings throughout the facility. LPA observed the facility has a 30-day supply of Personal Protective Equipment (PPE).

LPAs 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 todays visit: The licensee failed to ensure that a report was made to CCL within the next business day of being notified of a staff testing positive for COVID-19. During todays visit LPA's measured the hot water temperature in bathrooms #1 & #2 and it measured at 124.8 F

California Code of Regulations, Title 22, Division 6 and Chapter 1 are being cited on the attached LIC809D.

Exit interview held. A copy of the report and appeals was provided to Robbie M. Thompson, Administrator.
SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Ulysses Coronel
LICENSING EVALUATOR SIGNATURE:

DATE: 01/20/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/20/2022
LIC809 (FAS) - (06/04)
Page: 2 of 10
Document Has Been Signed on 01/20/2022 04:25 PM - It Cannot Be Edited


Created By: Ulysses Coronel On 01/20/2022 at 03:04 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: OPEN ARMS ADULT RESIDENTIAL FACILITY, LLC
FACILITY NUMBER: 198601513

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/20/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
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 and interview the licensee did not comply with the section cited above during todays visit hot water temperature in bathrooms #1 & #2 and it measured at 124.8 F, which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 01/21/2022
Plan of Correction
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During todays visit the administrator had staff adjust the water temperature. The administrator agreed to create a plan to ensure that temperature of hot water delivered to plumbing fixtures used by clients is not less than 105 degrees F (40.5 degrees C) and not more than 120 degrees F (48.8 degrees C). Proof of correction will be submitted to LPA Coronel at ulysses.coronel@dss.ca.gov by 01/21/2022.
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: 01/20/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/20/2022


LIC809 (FAS) - (06/04)
Page: 3 of 10
Document Has Been Signed on 01/20/2022 04:25 PM - It Cannot Be Edited


Created By: Ulysses Coronel On 01/20/2022 at 03:05 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: OPEN ARMS ADULT RESIDENTIAL FACILITY, LLC
FACILITY NUMBER: 198601513

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/20/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
80061(b)(1)(E)
80061(b)(1)(E) Reporting Requirements. Each licensee or applicant shall furnish to the licensing agency reports as required by the Department, including, but not limited to, those specified in this section.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.(1)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 , the licensee failed to report a staff testing positive for COVID-19 within the agency's next working day during its normal business hours, which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 01/27/2022
Plan of Correction
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The administrator will create a pan to ensure that unusual incident reports are submitted within the agency's next working day during its normal business hours. In addition, a written report shall be submitted to the licensing agency within seven days following the occurrence of such event. Proof of correction will be submitted by 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: 01/20/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/20/2022


LIC809 (FAS) - (06/04)
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