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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198601882
Report Date: 09/09/2024
Date Signed: 09/09/2024 12:06:07 PM

Document Has Been Signed on 09/09/2024 12:06 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:HARCOURT ADULT HOMEFACILITY NUMBER:
198601882
ADMINISTRATOR/
DIRECTOR:		LINDA HUDSONFACILITY TYPE:
735
ADDRESS:5200 ANGELES VISTA BLVDTELEPHONE:
(323) 295-4555
CITY:LOS ANGELESSTATE: CAZIP CODE:
90043
CAPACITY: 6CENSUS: 5DATE:
09/09/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:44 AM
MET WITH:Linda Hudson/AdministratorTIME VISIT/
INSPECTION COMPLETED:
12:05 PM
NARRATIVE
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On 9/9/24, Licensing Program Analyst Alfonso Iniguez, LPA, conducted an unannounced Case Management visit at the abovementioned facility. The LPA met with Linda Hudson, Administrator, and explained the reason for the visit.

El Segundo Regional Office received information that Congregate Connect has taken over the daily operations of the facilities from Wayfinder.

During the records review, LPA Iniguez observed that all the client’s records have a front face sheet with the name Congregate Connect LLC on the very top. In addition, LPA observed the client’s grievance procedures; on them, the name Congregate Connect is listed.

During a phone interview with Linda Hudson, the administrator, she stated that on 7/8/24, Congregate Connect came into this facility. LPA Gibbs confirmed with the administrator that Congregate Connect is handling the cost of daily operations. LPA Gibbs reviewed a total of (8) staff files, in the files there is Wayfinder and Junior Blinds of America.

The evaluation Report continues on the next page, LIC 809-C, providing further details of the inspection findings.

SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Alfonso Iniguez
LICENSING EVALUATOR SIGNATURE: DATE: 09/09/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/09/2024
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 3
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245
FACILITY NAME: HARCOURT ADULT HOME
FACILITY NUMBER: 198601882
VISIT DATE: 09/09/2024
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Deficiency cited under California Code of Regulations, Title 22, Division 6, Chapter 8. See details below:

-During a health and safety check at the facility, LPA Iniguez observed the lead staff (S#1) fall asleep and snore on the couch; LPA Iniguez had to wake them up since they were the only staff present, and a client was not appropriately supervised.

Note: *Citations not cleared by the due date will be a $100 fine assessed for each citation until it is cleared. Civil penalties will continue to accrue until Proof of Corrections (POC) is cleared. *

An exit interview was conducted, and a copy of the Facility Evaluation Report was provided to Linda Hudson / Administrator.

SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Alfonso Iniguez
LICENSING EVALUATOR SIGNATURE:

DATE: 09/09/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/09/2024
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 09/09/2024 12:06 PM - It Cannot Be Edited


Created By: Alfonso Iniguez On 09/09/2024 at 11:02 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
, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245

FACILITY NAME: HARCOURT ADULT HOME
FACILITY NUMBER: 198601882

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/09/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
09/23/2024
Section Cited
CCR
80078(a)

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80078 Responsibility for Providing Care and Supervision
(a) The licensee shall provide care and supervision as necessary to meet the client's needs.
This requirement was not met as evidence by:

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Licensee will ensure all facility clients are been properly supervised at all times. As Plan of Correction, licensee will re-train all facility staff, create an activity plan for client going out in the community. Administrator will send these plans to LPA via email.
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Based on observations, LPA observed lead staff fall asleep and snoring in the couch, LPA Iniguez had to wake them up since one of the client's was present and not been supervised.
This poses a potential health and safety risk to all residents 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:Eva M Alvarez
LICENSING EVALUATOR NAME:Alfonso Iniguez
LICENSING EVALUATOR SIGNATURE:
DATE: 09/09/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/09/2024


LIC809 (FAS) - (06/04)
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