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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198601623
Report Date: 11/09/2023
Date Signed: 11/09/2023 01:23:29 PM

Document Has Been Signed on 11/09/2023 01:23 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:PATE ENTERPRISES, INC. ( MENLO )FACILITY NUMBER:
198601623
ADMINISTRATOR:WESLEY PATE, JR.FACILITY TYPE:
735
ADDRESS:14801 GRAMERCY PLACETELEPHONE:
(213) 725-4634
CITY:GARDENASTATE: CAZIP CODE:
90249
CAPACITY: 6CENSUS: 4DATE:
11/09/2023
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
08:24 AM
MET WITH:Renita Campbell, AdministratorTIME COMPLETED:
01:30 PM
NARRATIVE
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On 11/9/23, Licensing Program Analyst (LPA) Felisa Shirley arrived at facility to investigate a complaint. During the course of the investigation, LPA Shirley toured the facility and observed two violations.

Based on the facility tour, LPA observed a mattress in the back room with discolored yellow circles on the surface covered in plastic with a strong urine smell. LPA observed two new twin mattresses in the facility. Administrator Renita stated that she will put mattresses on the bed when she gets mattress pads with a zipper to secure mattress. LPA also observed that the garage was locked and administrator did not have access.

Deficiencies are being cited based on LPA observations and interviews conducted in accordance with the California Code of Regulations, Title 22, Divisions 6 chapter 1, see LIC 809D.



An exit interview was conducted, Plans of Corrections were discussed and a copy of this report and appeals rights were and left with Administrator, Renita Campbell whose signature on this form confirms receipt of these documents.
SUPERVISORS NAME: Stephanie Cifuentes
LICENSING EVALUATOR NAME: Felisa Shirley
LICENSING EVALUATOR SIGNATURE: DATE: 11/09/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/09/2023
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 11/09/2023 01:23 PM - It Cannot Be Edited


Created By: Felisa Shirley On 11/09/2023 at 11:31 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: PATE ENTERPRISES, INC. ( MENLO )
FACILITY NUMBER: 198601623

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/09/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
11/23/2023
Section Cited
HSC
80044(a)(2)

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(a) The Licensing agency shall have the inspection authority specified in Health and Safety Code Sections (2) Any duly authorized officer, employee, or agent of the State Department of Social Services may, upon presentation of proper identification, enter and inspect any place providing personal care, supervision, and services at any time, with or without advance notice

This requirement is not met as evidenced by:
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Staff must have keys to garage in the future to allow representatives to inspect facility.
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Based on observation and interview, the licensee did not comply with the section cited above by not allowing access to the garage which poses a potential health, safety or personal rights risk to persons in care.
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Type B
11/23/2023
Section Cited
HSC85088(4)

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85088 Fixtures, Furniture, Equipment and Supplies (4) Clean linen in good repair, including lightweight, warm blankets and bedspreads; top and bottom bed sheets; pillow cases; mattress pads; rubber or plastic sheeting, when necessary; and bath towels, hand towels and washcloths.

This requirement is not met as evidenced by:
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Administrator will put new mattresses on the bed when
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Based on observation and interview, the licensee did not comply with regulation by having a soiled discolored mattress in residents room which poses a potential health, safety or personal rights risk to persons in care.
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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:Stephanie Cifuentes
LICENSING EVALUATOR NAME:Felisa Shirley
LICENSING EVALUATOR SIGNATURE:
DATE: 11/09/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/09/2023


LIC809 (FAS) - (06/04)
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