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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198601636
Report Date: 07/21/2023
Date Signed: 07/25/2023 08:13:58 AM

Document Has Been Signed on 07/25/2023 08:13 AM - 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 CNTR DR. ST 500
MONTEREY PARK, CA 91754
FACILITY NAME:HELP FOR BRAIN INJURED CHILDREN INC. - ADPFACILITY NUMBER:
198601636
ADMINISTRATOR:JASON CECILFACILITY TYPE:
775
ADDRESS:15915 RUSSELL STREETTELEPHONE:
(562) 694-5655
CITY:WHITTIERSTATE: CAZIP CODE:
90603
CAPACITY: 21CENSUS: 17DATE:
07/21/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Cory Bodda TIME COMPLETED:
02:55 PM
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Licensing Program Analyst (LPA) Angelica Rea conducted an unannounced required one year inspection at Help for Brain Injured Children Inc - ADP. LPA Rea met with Program Director Cory Bodda and explained the purpose for todays visit. There are currently seventeen (17) clients present.

During the visit, LPA Rea observed the following: Program directors office, Relaxation room, Activity room, Arts and Crafts room, Personal storage area for consumers, Reception area, Staff break room/storage area/staff bathroom(upstairs on the second floor), gated back yard area with shade, emergency supplies of food. (2) restrooms observed, kitchen area (contained a refrigerator, stove, coffee maker, and microwave) and laundry room area (washer and dryer). The Kitchen and restrooms, were clean and operable. Hot water was tested and the temperature measured within required range of 105-120 degrees. The facility fire alarm system has a pull switch. There are 3 fire extinguishers. Toxins are stored and inaccessible to clients. Clients bring lunch daily and the program provides a cooking program. As a part of the inspection, reviewed four (3) client records, and (3) staff files, and conducted interviews with staff and clients.

Deficiencies cited on 809-D. Copy of report and appeal rights were provided.
SUPERVISORS NAME: Lisa Hicks
LICENSING EVALUATOR NAME: Angelica Rea
LICENSING EVALUATOR SIGNATURE: DATE: 07/21/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/21/2023
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 07/25/2023 08:14 AM - It Cannot Be Edited


Created By: Angelica Rea On 07/21/2023 at 02:19 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 CNTR DR. ST 500
MONTEREY PARK, CA 91754

FACILITY NAME: HELP FOR BRAIN INJURED CHILDREN INC. - ADP
FACILITY NUMBER: 198601636

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/21/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
HSC
1503.2
General Provisions
Every facility licensed or certified pursuant to this chapter shall have one or more carbon monoxide detectors in the facility that meet the standards established in Chapter 8 (commencing with Section 13260) of Part 2 of Division 12. The department shall account for the presence of these detectors during inspections.

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 in LPA observed that the day program did not have a carbon monoxide detector as required, which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 07/28/2023
Plan of Correction
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Licensee shall ensure that the day program has a carbon monoxide detector as required, and will send proof of correction to LPA by POC due date.
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:Lisa Hicks
LICENSING EVALUATOR NAME:Angelica Rea
LICENSING EVALUATOR SIGNATURE:
DATE: 07/21/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/21/2023


LIC809 (FAS) - (06/04)
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