198602392-6-8-2022-28-AS-LMOA-CF7RED-20220608125722

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 198602392
Report Date: 06/08/2022
Date Signed: 06/08/2022 12:57:31 PM

Document Has Been Signed on 06/08/2022 12:57 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
CCLD Regional Office, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754

FACILITY NAME:	CHOICES R US - STOAKES		FACILITY NUMBER:	198602392
ADMINISTRATOR:	MARC SWEET		FACILITY TYPE:	735
ADDRESS:	9022 STOAKES AVE		TELEPHONE:	(562) 445-3009
CITY:	DOWNEY	STATE: CA	ZIP CODE:	90240
CAPACITY: 4		CENSUS: 4	DATE:	06/08/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	09:30 AM
MET WITH:	Marc Sweet - Administrator		TIME COMPLETED:	01:00 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) Luis Mora conducted an unannounced annual visit at the facility with focus on the infection control domain, medication and food review. LPA Mora met with Administrator Marc Sweet and explained the reason for the visit. The facility is licensed to serve 4 ambulatory only clients in the age range of 18 through 59. There are currently 4 ambulatory clients serviced by South Central Los Angeles Regional Center.

The facility is in a residential area and it is a one story family home. A tour of the single-story facility included the living room, kitchen, dining area, 4 client bedrooms, 2 bathrooms, laundry area, front yard, backyard, and detached garage.

LPA Mora conducted the tour with Marc Sweet and observed the following: sufficient food supplies for at least 2 days of perishables and 7 days of non-perishables were observed in the kitchen. Sharps were observed locked in the medication closet. Chemical and cleaning solutions are kept locked under the kitchen sink. The First Aid kit is kept locked in a kitchen cabinet and it is fully stocked with all required items including a current manual. Clean towels and extra clean linen were observed in each bedroom. Dining and living room have sufficient lighting and sitting area. Medications are kept locked in the medication closet in the hallway. Client and staff files are kept in the medication closet. All bedrooms have all required furniture, lighting, and bedding. All bathrooms were observed with shower mats. The water temperature was tested in both bathrooms and measured at 109.4 degrees F and 114.8 degrees F, which is within the required 105-120 degrees F. A fire extinguisher was observed in the kitchen and it is fully charged. Smoke detectors were observed throughout the facility and in each room and were operable during the visit. There is a carbon monoxide in the hallway and was operable during the visit. The front yard and backyard are clean. There is a shaded area with seating in the backyard. No bodies of water were observed at the facility. Passageways and exits are free of obstruction.

(CONTINUED TO LIC 809C)

SUPERVISORS NAME: Stefanie Coronel
LICENSING EVALUATOR NAME: Luis Mora
LICENSING EVALUATOR SIGNATURE:	DATE: 06/08/2022

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/08/2022

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 3

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 CNTR DR. ST 500
MONTEREY PARK, CA 91754

FACILITY NAME: CHOICES R US - STOAKES	FACILITY NUMBER: 198602392
	VISIT DATE: 06/08/2022

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
26
27
28
29
30
31
32

LPA reviewed medication for all four clients and observed that medications are documented properly and given as prescribed. LPA reviewed files for all four clients and observed the following: Client 1 - Client 4 (C1 - C4) did not have a current Needs and Service Plan or an Individual Program Plan (IPP). The plans in the clients’ files dated back to 2017 & 2018. LPA reviewed two staff files and observed no issues. LPA observed administrator certificate for Marc Sweet - 6042972735 with an expiration date of 06/25/2023.

Facility has 30 days supplies of Personal Protective Equipment in the living room. Facility is following COVID-19 recommendations regarding screening visitors, staff, and clients. Covid-19 prevention signs are posted throughout the facility and hand-washing signs were observed in the bathrooms. Sufficient hand soap, hand sanitizer, and paper towels were observed.

Per California Code of Regulations, Title 22, and California Health and Safety Code, there were deficiencies observed during the visit (Refer to LIC 809D). Exit interview held and a copy of the report and appeal rights were provided.

SUPERVISORS NAME: Stefanie Coronel
LICENSING EVALUATOR NAME: Luis Mora
LICENSING EVALUATOR SIGNATURE:	DATE: 06/08/2022

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/08/2022

LIC809 (FAS) - (06/04)

Page: 2 of 3

Document Has Been Signed on 06/08/2022 12:57 PM - It Cannot Be Edited

Created By: Luis Mora On 06/08/2022 at 12:15 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 - STOAKES	FACILITY NUMBER: 198602392
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 06/08/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

85068.3(a)

85068.3(a) Modifications to Needs and Services Plan (a) The written Needs and Services Plan specified in Section 85068.2 shall be updated as frequently as necessary to ensure its accuracy, and to document significant occurrences that result in changes in the client's physical, mental and/or social functioning. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on record review, the licensee did not comply with the section cited above in 4 out of 4 client files. Client 1 - Client 4 (C1 - C4) had a Needs and Services Plan and Individual Program Plan dated 2017 & 2018 which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 06/22/2022
	Plan of Correction
1 2 3 4	Licensee will obtain a current Needs and Services Plan and Individual Program Plan. A copy will be submitted to the LPA by the POC due date 06/22/2022.

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:

Stefanie Coronel

LICENSING EVALUATOR NAME:

Luis Mora

LICENSING EVALUATOR SIGNATURE:

DATE: 06/08/2022

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/08/2022

LIC809 (FAS) - (06/04)

Page: 3 of 3