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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198601891
Report Date: 12/28/2022
Date Signed: 12/28/2022 03:59:35 PM

Document Has Been Signed on 12/28/2022 03:59 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, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754
FACILITY NAME:OPEN ARMS, LOVING HANDSFACILITY NUMBER:
198601891
ADMINISTRATOR:VANESSA LEEFACILITY TYPE:
735
ADDRESS:2702 WEST 77TH STREETTELEPHONE:
(424) 380-0120
CITY:INGLEWOODSTATE: CAZIP CODE:
90305
CAPACITY: 6CENSUS: 1DATE:
12/28/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:01 PM
MET WITH:Vanessa Lee, AdministratorTIME COMPLETED:
04:00 PM
NARRATIVE
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Licensing Program Analyst (LPA) Mario Leon conducted an unannounced Annual required visit with a primary focus on infection control measures. LPA was met by Vanessa Lee, Administrator, and the purpose of today’s visit was explained. The facility is licensed to serve 6 developmentally disabled clients (age 18-59). There is currently One (1) Westside Regional Center client in placement.

LPA was properly screened for COVID-19 symptoms and temperature was checked. LPA observed a sanitizing station at the facility front entrance; visitors log with COVID-19 screening and temperature log, and records of daily COVID-19 screening and temperature checks of residents and staff. PPE supplies are readily available to staff, and an additional 30-day supply of PPE is stored in the storage closet; sufficient paper products, cleaning and disinfecting supplies were observed. LPA verified that the facility has an approved Mitigation Plan Report. Ms. Lee stated all staff, beside herself, and client one (1) are fully vaccinated.

LPA Leon toured the entire facility inside and outside grounds. There are no bodies of water or firearms/ammunition on the premises. All client rooms were checked. Beds and bedding were in good condition, adequate lighting was provided, storage for client personal belongings was observed. Walls and floors were in good repair. Bed linens, comforters, and bath towels were adequately stocked at the time of visit. The facility is a single-story family home located in a residential neighborhood. The facility consisted of the following: Living room, dining room, kitchen, four (4) bedrooms, two (2) bathrooms, laundry closet, indoor/outdoor activity area, covered patio shaded area, detached two (2) car garage, front and back yard landscape is in good condition at the time of visit. Documents were posted as mandated. Bedrooms #1-4 are designated as client's bedrooms.
See LIC809-C
SUPERVISORS NAME: Ulysses Coronel
LICENSING EVALUATOR NAME: Mario Leon
LICENSING EVALUATOR SIGNATURE: DATE: 12/28/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/28/2022
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 5
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754
FACILITY NAME: OPEN ARMS, LOVING HANDS
FACILITY NUMBER: 198601891
VISIT DATE: 12/28/2022
NARRATIVE
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Bathrooms were found to be clean and operational, yet not within Title 22 regulations. The water temperature measured at an average of 140F. A comfortable temperature is maintained in the facility. LPA observed the facility to be clean and appropriately furnished at the time of visit. Storage areas for personal hygiene and sharps were inaccessible to clients. The kitchen was inspected and there is enough perishable and non-perishable food available which is stored properly. Fire extinguisher was not charged, smoke detectors and Carbon Monoxide were operable.

LPA advised the Administrator to continuously monitor the Centers for Disease Control (CDC) website and Community Care Licensing Provider Informational Notices (PIN) for any updates relating to COVID-19 guidance.



During today’s visit there were five (5) deficiencies observed, see LIC809-D

Exit interview held. A copy of the report was provided to Vanessa Lee, Administrator.

SUPERVISORS NAME: Ulysses Coronel
LICENSING EVALUATOR NAME: Mario Leon
LICENSING EVALUATOR SIGNATURE:

DATE: 12/28/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/28/2022
LIC809 (FAS) - (06/04)
Page: 2 of 5
Document Has Been Signed on 12/28/2022 03:59 PM - It Cannot Be Edited


Created By: Mario Leon On 12/28/2022 at 03:26 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: OPEN ARMS, LOVING HANDS
FACILITY NUMBER: 198601891

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/28/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
80087(a)
Building and Grounds
(a) The facility shall be clean, safe, sanitary and in good repair at all times for the safety and well-being of clients, employees and visitors.

This requirement is not met as evidenced by:
Deficient Practice Statement
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2
3
4
Based on LPA Leon's observation, fire extinguisher is leaking retardant has not been recharged and is currently in disrepair, the licensee did not comply with the section cited above which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 12/30/2022
Plan of Correction
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2
3
4
Administrator has agreed to replace the current fire extinguisher before this coming Friday, 12/30/2022
Type A
Section Cited
CCR
80088(d)
Fixtures, Furniture, Equipment, and Supplies
(d) The licensee shall provide lamps or lights as necessary in all rooms and other areas to ensure the comfort and safety of all persons in the facility.

This requirement is not met as evidenced by:
Deficient Practice Statement
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2
3
4
Based on LPA Leon's observation, the licensee did not comply with the section cited above in client's bedroom which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 12/28/2022
Plan of Correction
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Administrator will replace the light bulb in the overhead fan prior to the plan of corrections due date and submit, electronically, to LPA Leon.
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:Ulysses Coronel
LICENSING EVALUATOR NAME:Mario Leon
LICENSING EVALUATOR SIGNATURE:
DATE: 12/28/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/28/2022


LIC809 (FAS) - (06/04)
Page: 3 of 5
Document Has Been Signed on 12/28/2022 03:59 PM - It Cannot Be Edited


Created By: Mario Leon On 12/28/2022 at 03:26 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: OPEN ARMS, LOVING HANDS
FACILITY NUMBER: 198601891

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/28/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
80088(e)(1)
Fixtures, Furniture, Equipment, and Supplies
(e) Faucets used by clients for personal care such as shaving and grooming shall deliver hot water. (1) Hot water temperature controls shall be maintained to automatically regulate temperature of hot water delivered to plumbing fixtures used by clients to attain a hot water temperature of not less than 105 degrees F (40.5 degrees C) and not more than 120 degrees F (48.8 degrees C).

This requirement is not met as evidenced by:
Deficient Practice Statement
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2
3
4
Based on LPA Leon's observation, the licensee did not comply with the section cited above in having a water temperature at 140F which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 12/30/2022
Plan of Correction
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2
3
4
Administrator has agreed to submit proof of change of water temperature, electronically, to LPA Leon prior to the above correction date.
Section Cited
Deficient Practice Statement
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2
3
4
POC Due Date:
Plan of Correction
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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:Ulysses Coronel
LICENSING EVALUATOR NAME:Mario Leon
LICENSING EVALUATOR SIGNATURE:
DATE: 12/28/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/28/2022


LIC809 (FAS) - (06/04)
Page: 4 of 5
Document Has Been Signed on 12/28/2022 03:59 PM - It Cannot Be Edited


Created By: Mario Leon On 12/28/2022 at 03:26 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: OPEN ARMS, LOVING HANDS
FACILITY NUMBER: 198601891

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/28/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
80087(g)
Building and Grounds
(g) Disinfectants, cleaning solutions, poisons, firearms and other items that could pose a danger if readily available to clients shall be stored where inaccessible to clients.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on LPA Leon's observation, the licensee did not comply with the section cited above in having cleaning agents located below bathroom number two (2) sink, which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 12/30/2022
Plan of Correction
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Administrator has agreed to relocate all cleaning agents to an inaccessible location prior to the plan of corrections date agreed upon.
Type B
Section Cited
CCR
80088(b)
Fixtures, Furniture, Equipment, and Supplies
(b) All window screens shall be in good repair and be free of insects, dirt and other debris.

This requirement is not met as evidenced by:
Deficient Practice Statement
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3
4
Based on LPA Leon's observation the licensee did not comply with the section cited above in client's personal bathroom, which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 01/13/2023
Plan of Correction
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3
4
Administrator has agreed to have the screen repaired and have submitted proof, electronically, prior to the plan of corrections due date above.
Mario.Leon@DSS.CA.GOV
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:Ulysses Coronel
LICENSING EVALUATOR NAME:Mario Leon
LICENSING EVALUATOR SIGNATURE:
DATE: 12/28/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/28/2022


LIC809 (FAS) - (06/04)
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