198601884-11-9-2023-11-AS-EGOZ-CXETJW-20231109134702

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 198601884
Report Date: 11/09/2023
Date Signed: 11/09/2023 01:47:31 PM

Document Has Been Signed on 11/09/2023 01:47 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, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754

FACILITY NAME:	SOLID FOUNDATION WEIGHT MANAGEMENT INC.		FACILITY NUMBER:	198601884
ADMINISTRATOR:	CARLA Y. GALVAN		FACILITY TYPE:	775
ADDRESS:	4167 W.WASHINGTON BLVD.		TELEPHONE:	(323) 731-1358
CITY:	LOS ANGELES	STATE: CA	ZIP CODE:	90016
CAPACITY: 105		CENSUS: 37	DATE:	11/09/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	08:21 AM
MET WITH:	Carla Galvan		TIME COMPLETED:	02:15 PM

NARRATIVE

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On 11/09/23 Licensing Program Analyst (LPA) Elvira Gonzalez conducted an unannounced annual required visit using the CARE Inspection Tool. LPA met with Administrator Carla Galvan, and the purpose of today’s visit was explained. LPA was granted access to the facility. The facility is licensed to serve 105 ambulatory only clients over the age of 18 years. Today’s census was 37. As a part of the inspection, LPA reviewed client records, staff records, medications, and inspected the entire facility. The last fire drill was conducted on 7/31/2023. The last earthquake drill was conducted on 10/19/23.

The facility is a single-story structure located in a business building. It consists of the following: four (4) activity rooms, two offices, cafeteria, kitchen, and four restrooms.

LPA and Administrator Carla Galvan toured the physical plant. All rooms were inspected. The facility walls/ floors were in good condition, and there is adequate lighting throughout the facility. The kitchen and cafeteria are clean and well maintained. The bathrooms were found to be within Title 22 regulation. Client men’s restroom measured at 105.7 F, client women’s bathroom measured at 105.3 F, staff bathroom #1 measured at 106.3 F and staff bathroom #2 measured at 106.9 F. A comfortable temperature was maintained in the facility.

The kitchen was inspected, and sufficient perishable and non-perishable food was maintained adequately. The fire extinguishers were properly charged, smoke and carbon monoxide detectors are operational. The first aid kit was stocked with manual and available for use. Exits/ Walkways around the facility were free of debris and hazards. The facility is in good repair. The program is not currently administering medications. Toxins and sharps were locked and inaccessible to clients. Outside grounds were toured and no bodies of water were observed.

Continued on LIC 809-C

SUPERVISORS NAME: Stephanie Cifuentes
LICENSING EVALUATOR NAME: Elvira Gonzalez
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 01:47 PM - It Cannot Be Edited

Created By: Elvira Gonzalez On 11/09/2023 at 01:06 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 DR #100
MONTEREY PARK, CA 91754

FACILITY NAME: SOLID FOUNDATION WEIGHT MANAGEMENT INC.	FACILITY NUMBER: 198601884
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 11/09/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

82065(g)(1)

Personnel Requirements

(1) The good physical health of each employee and individual licensee shall be verified by a health screening, including negative test results for tuberculosis, performed by or under the supervision of a physician not more than one year prior to or seven days after employment or licensure. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation, interview, and record review, the licensee did not comply with the section cited above in 5 out of 6 staff records, which poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 12/08/2023
	Plan of Correction
1 2 3 4	Administrator is to provide a copy of Health Screening or have a new Health Screening performed and send copy to LPA Gonzalez on or before POC due date.

Section Cited


	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

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:

Elvira Gonzalez

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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754

FACILITY NAME: SOLID FOUNDATION WEIGHT MANAGEMENT INC.	FACILITY NUMBER: 198601884
	VISIT DATE: 11/09/2023

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During the visit, LPA observed the facility's infection control practices. LPA observed screening protocols for visitors, staff, and residents, sanitizing stations in common areas and restrooms. LPA observed the facility has a 30-day supply of Personal Protective Equipment (PPE). All mandated inspection control posters were posted. The facility has an approved CCLD Mitigation Plan.

During the inspection, while LPA was doing staff records review, LPA observed that 5 out 6 staff Health screenings were not on file.

Deficiencies were issued and an exit interview was conducted and a copy of this report along with the appeal rights was provided to Administrator Carla Galvan.

SUPERVISORS NAME: Stephanie Cifuentes
LICENSING EVALUATOR NAME: Elvira Gonzalez
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

LIC809 (FAS) - (06/04)

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