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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198601513
Report Date: 04/26/2024
Date Signed: 04/26/2024 02:25:05 PM

Document Has Been Signed on 04/26/2024 02:25 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
EL SEGUNDO ASC, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245
FACILITY NAME:OPEN ARMS ADULT RESIDENTIAL FACILITY, LLCFACILITY NUMBER:
198601513
ADMINISTRATOR/
DIRECTOR:		ROBYN M. THOMPSONFACILITY TYPE:
735
ADDRESS:229 SOUTH LOCUST AVENUETELEPHONE:
(310) 346-3447
CITY:COMPTONSTATE: CAZIP CODE:
90221
CAPACITY: 4CENSUS: 4DATE:
04/26/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:52 AM
MET WITH:Licensee/Administrator Robyn M. ThompsonTIME VISIT/
INSPECTION COMPLETED:
01:30 PM
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 On 04/26/24 Licensing program analyst (LPA) Villegas conducted a case management visit in response to special incident report submitted to CCLD on 04/23/24 for incident occurring on 04/22/24; regarding client #1 (C1) assaulting client #2 (C2). During todays' visit LPA met in person with Licensee/Administrator
Robyn M. Thompson, South central regional center service coordinator, behaviorist, C1, C1's conservator (W1), and day program Program Director (PD) who participated via zoom. Client #1 requires ASL, South Central Regional Center Service Coordinator know ASL.

During today's visit LPA Villegas Conducted a health and safety visit which consisted of the following: LPA toured physical plant. obtained copies of client #1's (Facesheet, physicians report, med list, IPP, behavior plan, incident reports for the last 6 months if any), client roster, and staff roster. LPA also requested the following documents for staff #1 (S1); LIC 501, SOC 341(a),first aide certification, and CPI training. All documents to be scanned and emailed to LPA by 04/29/2024, Lizeth.villegas@dss.ca.gov.

Due to insufficient information available at this time, the above allegations need further follow up.

No immediate health and safety issues were observed.
SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Lizeth Villegas
LICENSING EVALUATOR SIGNATURE: DATE: 04/26/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/26/2024
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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