<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198601806
Report Date: 07/25/2023
Date Signed: 07/25/2023 04:00:48 PM

Document Has Been Signed on 07/25/2023 04:00 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
GREATER LA AC/SC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754
FACILITY NAME:CHOICES R US - DOROTHYFACILITY NUMBER:
198601806
ADMINISTRATOR:DANIEL GODFREYFACILITY TYPE:
735
ADDRESS:10008 DOROTHY AVETELEPHONE:
(562) 445-3009
CITY:SOUTH GATESTATE: CAZIP CODE:
90280
CAPACITY: 4CENSUS: 4DATE:
07/25/2023
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
03:44 PM
MET WITH:Gil Martinez - AdministratorTIME COMPLETED:
04:15 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
Licensing Program Analyst (LPA) Bennette Pena initiated a Case Management- Deficiencies after it was discovered during the course of the investigation for complaint control # 28-AS-20230724133547 that the facility did not maintain a comfortable temperature in rooms that clients occupy between a minimum of 68 deg F and a maximum of 85 degrees F. Administrator stated that he already made Regional Center aware of the broken A/C and waiting for the service personnel to fix it.

A citation was issued.

Per California Code of Regulations, Title 22, and California Health and Safety Code, the deficiency observed during the visit on 7/21/2023 is documented on 809D.

Exit interview held and a copy of the report along with appeal rights were provided to Gil Martinez, Administrator.

SUPERVISORS NAME: David Sicairos
LICENSING EVALUATOR NAME: Bennette Pena
LICENSING EVALUATOR SIGNATURE: DATE: 07/25/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/25/2023
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 2
Document Has Been Signed on 07/25/2023 04:00 PM - It Cannot Be Edited


Created By: Bennette Pena On 07/25/2023 at 03:45 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: CHOICES R US - DOROTHY
FACILITY NUMBER: 198601806

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/25/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
08/02/2023
Section Cited
CCR
80088(a)(1)

1
2
3
4
5
6
7
80088 Furniture, Fixtures, Equipment, and Supplies...(a) A comfortable temperature for clients shall be maintained....(1) The licensee shall maintain the temperature ..... between a minimum of 68 degrees F (20 degrees C) and a maximum of 85 degrees F (30 degrees C). (A) In areas of extreme heat the maximum shall be 30 degrees F (16.6 degrees C) less than the outside temperature.
This requirement was not met evidenced by:
1
2
3
4
5
6
7
Administrator shall maintain a comfortable temperature for the clients and agreed to submit a written plan of correction on how to keep the temperature in rooms that clients occupy between a minimum of 68 degrees F and a maximum of 85 degrees F and submit plan to LPA/CCL by POC due date.
8
9
10
11
12
13
14
LPA observed that at 3:50pm, the temperature in the facility read at 89 deg F which poses a potential health and safety risk to clients in care.
8
9
10
11
12
13
14

1
2
3
4
5
6
7
1
2
3
4
5
6
7

1
2
3
4
5
6
7
1
2
3
4
5
6
7
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:Bennette Pena
LICENSING EVALUATOR SIGNATURE:
DATE: 07/25/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/25/2023


LIC809 (FAS) - (06/04)
Page: 2 of 2