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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198601636
Report Date: 06/13/2024
Date Signed: 06/13/2024 01:20:23 PM

Document Has Been Signed on 06/13/2024 01:20 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
MONTEREY PARK ASC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754
FACILITY NAME:HELP FOR BRAIN INJURED CHILDREN INC. - ADPFACILITY NUMBER:
198601636
ADMINISTRATOR/
DIRECTOR:		JASON CECILFACILITY TYPE:
775
ADDRESS:15915 RUSSELL STREETTELEPHONE:
(562) 694-5655
CITY:WHITTIERSTATE: CAZIP CODE:
90603
CAPACITY: 21CENSUS: DATE:
06/13/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:18 AM
MET WITH:Cory Bodda, Program DirectorTIME VISIT/
INSPECTION COMPLETED:
01:30 PM
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Licensing Program Analysts (LPAs) Daniel Konishi and Christine Wong conducted an unannounced annual inspection at the facility. LPAs met with Cory Bodda / Program Director and explained the purpose of the visit. The facility is licensed to serve age 18 and over. 21 ambulatory of which maybe 6 non-ambulatory developmentally disabled clients.

LPAs utilized the Compliance and Regulatory Enforcement (CARE) Tools which contain the following domains: Infection Control, Physical Plant & Environment Safety, Operational Requirements, Staffing, Personnel Reports-Training, Client Rights - Information, Client Records-Incident Report, Food Services, Health Related Services, Incidental Medical Services, Disaster Preparedness, Emergency Intervention.



1. Infection Control: Facility has an updated infection control plan in place. Facility continues to practice the infection control in the facility. Facility also has sufficient PPE supplies in the facility.

2. Physical Plant and Environmental Safety: During the visit, LPAs observed the following: Program Director's 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 between 112-114.8 degrees which is within the Title 22 regulation. All the chemicals and cleaning supplies are stored and locked in the janitor closet. All the sharp knives are stored and locked in the staff break room file cabinet. The facility has a quiet room for clients to rest if they do not feel good. The passageway and walkway are free of obstruction. LPAs inspected the carbon monoxide detectors in the facility and it's working well. Facility has drinking water available for client to use.
SUPERVISORS NAME: David Sicairos
LICENSING EVALUATOR NAME: Daniel Konishi
LICENSING EVALUATOR SIGNATURE: DATE: 06/13/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/13/2024
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK ASC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754
FACILITY NAME: HELP FOR BRAIN INJURED CHILDREN INC. - ADP
FACILITY NUMBER: 198601636
VISIT DATE: 06/13/2024
NARRATIVE
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3. Operational Requirement: Currently there's about 4 clients are non-ambulatory and one client that is bedridden, facility is not within fire clearance.

4. Staffing: Facility has sufficient staffing in the facility and the regional center staff and client ratio are 1:3 and the facility does have the required ratio.

5. Personnel Record-Training: All the staff files are computerized and the Program Director has access to it. All the staff in the facility are fingerprint cleared and associated with the facility. All the staff have updated health screening and TB test results. All the staff also have the required 8 hours in service training.

6. Client's Record-Incident Reports: All the client's files are computerized and the Program Director has access to it. All the client have the documents included face sheet, health screening, and TB Test results. Client #1 to #3 do not have a admission agreement on file. Client #3 does not have a updated (IPP) Individual Program Plan.

7. Client's Right-Information: There are currently no postural supports in the facility.

8. Food Service: Clients will bring their own snacks and lunch to the day program and facility staff would assist them to heat up the food. Drinking water is available for client in the facility if needed. All the food are stored properly in the client's kitchen and staff kitchen. All food and adequate utensils such as, dishes, cups, bowls, and plates observed.

9. Health Related Services: The medication is centrally stored and locked in a cabinet in the Program Director's office and currently two clients are taking medication in the facility. LPAs checked the MARs for two (2) clients and the medications were updated. The Physician's Report of Client #4 states that the Client requires assistance of medication and currently self-medicated. All facility staff have the updated first aid, CPR, and AED certificates. First aid kit observed and have the required supplies.

10. Incidental Medical Services: Currently, no client in the facility has any restricted health conditions.

SUPERVISORS NAME: David Sicairos
LICENSING EVALUATOR NAME: Daniel Konishi
LICENSING EVALUATOR SIGNATURE:

DATE: 06/13/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/13/2024
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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
MONTEREY PARK ASC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754
FACILITY NAME: HELP FOR BRAIN INJURED CHILDREN INC. - ADP
FACILITY NUMBER: 198601636
VISIT DATE: 06/13/2024
NARRATIVE
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11. Disaster Preparedness: The facility has an updated Emergency Disaster Plan but it hasn't been updated. The last Emergency Disaster / Fire Drill was conducted on 04/23/2024.

12. Emergency Intervention: The facility does not use any restraints on clients but all staff CPI trained and they all have updated CPI certificates.

Deficiencies noted on todays visit per Title 22 Division 6 Chapter 3. Appeal rights discussed and a copy given during visit. Exit interview conducted with the Program Director.
SUPERVISORS NAME: David Sicairos
LICENSING EVALUATOR NAME: Daniel Konishi
LICENSING EVALUATOR SIGNATURE:

DATE: 06/13/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/13/2024
LIC809 (FAS) - (06/04)
Page: 6 of 6
Document Has Been Signed on 06/13/2024 01:20 PM - It Cannot Be Edited


Created By: Daniel Konishi On 06/13/2024 at 12:14 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: 06/13/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
82075(b)
Health-Related Services
(b) Clients shall be assisted as needed with self-administration of prescription and nonprescription medications.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, LPA observed Client #4 Physician Report indicated client needs assistance with medication and currently client is self-administrating medication which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 06/14/2024
Plan of Correction
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The Administrator will contact the Client # 4 family and request the updated physician's report to determine if the client to self-administer medication. The Administrator will send the plan on how to manage the client's medication by the POC due date 06/14/2024.
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:David Sicairos
LICENSING EVALUATOR NAME:Daniel Konishi
LICENSING EVALUATOR SIGNATURE:
DATE: 06/13/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/13/2024


LIC809 (FAS) - (06/04)
Page: 2 of 6
Document Has Been Signed on 06/13/2024 01:20 PM - It Cannot Be Edited


Created By: Daniel Konishi On 06/13/2024 at 12:14 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: 06/13/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
82020
Fire Clearance
All day programs shall secure through the licensing agency and maintain a fire clearance approved by the city or county fire department, the district providing fire protection services, or the State Fire Marshal.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, LPAs reviewed client #1 Physician's Report which indicated the client is bedridden which violates the facility's fire clearance status which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 06/20/2024
Plan of Correction
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The Administrator will ensureto follow the fire clearance requirement and also obtain Client # 1's updated Physician's Report about the ambulatory status and send to LPA by POC due date 06/20/2024.
Type B
Section Cited
CCR
82068(a)
Admission Agreements
(a) The licensee shall complete and maintain an individual written admission agreement with each client and the client's authorized representative, if any.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, LPA reviewed Client #1 to Client #3 do not have the Admission Agreement in the clients' files which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 07/11/2024
Plan of Correction
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The Administrator will send Client #1 and Client #3, copy of Admission Agreement by the 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:David Sicairos
LICENSING EVALUATOR NAME:Daniel Konishi
LICENSING EVALUATOR SIGNATURE:
DATE: 06/13/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/13/2024


LIC809 (FAS) - (06/04)
Page: 3 of 6
Document Has Been Signed on 06/13/2024 01:20 PM - It Cannot Be Edited


Created By: Daniel Konishi On 06/13/2024 at 12:14 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: 06/13/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
82068.2(d)(1)
Needs and Services Plan
(d) If the client has an existing needs appraisal or individual program plan (IPP) completed by a placement agency, or a consultant for the placement agency, the Department may consider the plan to meet the requirements of this section provided that: (1) The needs appraisal or IPP is not more than one year old.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, LPA reviewed Client #3 does not have an updated Individual Program Plan (IPP) which the last IPP was dated on July 2020 which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 07/04/2024
Plan of Correction
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The Administrator will send the updated Client #3 an updated IPP by the 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:David Sicairos
LICENSING EVALUATOR NAME:Daniel Konishi
LICENSING EVALUATOR SIGNATURE:
DATE: 06/13/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/13/2024


LIC809 (FAS) - (06/04)
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