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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198602077
Report Date: 06/11/2022
Date Signed: 06/12/2022 07:44:33 AM

Document Has Been Signed on 06/12/2022 07:44 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754
FACILITY NAME:LIVING WELL 2FACILITY NUMBER:
198602077
ADMINISTRATOR:JUSTICE, RICHARDFACILITY TYPE:
735
ADDRESS:434 W. SCHOOL STREETTELEPHONE:
(424) 296-5408
CITY:COMPTONSTATE: CAZIP CODE:
90220
CAPACITY: 4CENSUS: 3DATE:
06/11/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:44 PM
MET WITH:Karon PowellTIME COMPLETED:
02:30 PM
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On 06/11/22, at 12:44 p.m., Licensing Program Analyst (LPA)/ Susan Campos conducted an unannounced annual required visit with a primary focus on Infection Control measures using the new CARE Inspection Tool. LPA met with Karon Powell, Administrator and explained the purpose of today’s visit. Licensed to serve 4 ambulatory clients ages 18 to 59. This facility is a level 4I home that is vendorized with the South-Central Los Angeles Regional Center. The last fire drill was conducted January 15, 2022. LPA Campos and Ms. Powell toured the entire facility inside and outside grounds.

The facility is a single-story residential home located in a residential neighborhood. The home consists of the following: 3 bedrooms, 1 bathroom, family room, kitchen, living room, shaded area, indoor and outdoor activity area, laundry room and a de-attached garage.

The LPA and Ms. Powell toured the physical plant. There were no bodies of water or obstructions on the premises. All rooms were inspected. Beds and bedding supplies were in good condition, adequate lighting provided, storage for resident personal belongings was observed. Bed linens, comforters, and bath towels were adequately stocked at the time of visit. Bathrooms were found to be within Title 22 regulations and were clean and operational. The facility hot water temperature measured 107.9 degrees Fahrenheit. A comfortable temperature of 75 degrees Fahrenheit was maintained in the facility.

LPA observed the facility to be sanitary and appropriately furnished at the time of visit. Storage areas for personal hygiene, cleaning supplies, toxins, and sharps objects were stored and not accessible to residents. The kitchen was inspected and there is sufficient perishable and non-perishable food available and maintained properly. The facility fire extinguisher is charged. Smoke detectors and carbon monoxide are operable. A review of Medication Administration Records (MAR) was observed to be maintained in order and accurate.

Evaluation Report Continued on LIC 809-C

SUPERVISORS NAME: Ulysses Coronel
LICENSING EVALUATOR NAME: Susan Campos
LICENSING EVALUATOR SIGNATURE: DATE: 06/11/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/11/2022
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
CCLD Regional Office, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754
FACILITY NAME: LIVING WELL 2
FACILITY NUMBER: 198602077
VISIT DATE: 06/11/2022
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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. The LPA observed staff were wearing face coverings, LPA observed the facility has a 30-day supply of Personal Protective Equipment (PPE). All mandated inspection control posters were posted. A review of staff and resident temperature logs were reviewed.

No deficiencies were cited during this inspection visit.

An exit interview was conducted and a copy of this report was provided to Karon Powell.

SUPERVISORS NAME: Ulysses Coronel
LICENSING EVALUATOR NAME: Susan Campos
LICENSING EVALUATOR SIGNATURE:

DATE: 06/11/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/11/2022
LIC809 (FAS) - (06/04)
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