198602394-10-29-2023-28-AS-THEA-CX3QQU-20231029122255

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 198602394
Report Date: 10/29/2023
Date Signed: 10/29/2023 12:23:01 PM

Document Has Been Signed on 10/29/2023 12:23 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
GREATER LA AC/SC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754

FACILITY NAME:	DOWNEY HOME		FACILITY NUMBER:	198602394
ADMINISTRATOR:	MILIAN, GURITH		FACILITY TYPE:	735
ADDRESS:	11403 HORTON AVENUE		TELEPHONE:	(562) 682-2417
CITY:	DOWNEY	STATE: CA	ZIP CODE:	90241
CAPACITY: 4		CENSUS: 4	DATE:	10/29/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	09:07 AM
MET WITH:	Beatriz Milian-Torres		TIME COMPLETED:	12:30 PM

NARRATIVE

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Licensing Program Analyst (LPA) Tena Herrera conducted the required unannounced annual inspection. LPA met with House Manager Maria (Maricela) Rodriguez and Administrator Beatriz Milian-Torres and explained the reason for the visit. The facility is licensed to serve four ambulatory clients ages 18-59. Facility currently has 4 ambulatory clients serviced by South Central Los Angeles Regional Center.

The facility is a single-story home located in a residential area in Downey, Ca. A tour of the facility includes: 2 living rooms, dining room, kitchen, laundry area, pantry, medication closet, office room, 2 bathrooms, 2 client bedrooms, 1 staff bedroom, detached garage, detached shed, front yard, and back yard with shaded patio.

Infection Control: The facility staff are using appropriate hand hygiene and gloves while assisting clients’ medications. Staff are still cleaning and disinfecting throughout the day. Facility has sufficient PPE supplies and has an Infection Control Plan maintained at the facility.

Physical Plant & Environment Safety: LPA toured facility, clients’ bedrooms were checked and closet/drawer space to accommodate each client comfortably was available. The backyard is free of debris/hazards and the outdoor and passageways are free of obstruction. No bodies of water were observed at the facility. There are no security bars or weapons on the premises. Hygiene products are readily available for clients. The hot water temperature in both client bathrooms were tested and measured between 113.9-119.7 degrees F which within the required range of 105-120 degrees F. All storage areas for cleaning solutions, toxins, knives, and hazardous items are kept in a locked and are inaccessible to clients. Smoke detectors and carbon monoxide detectors are operable and in compliance. There fire extinguisher was observed and is fully charged.
Operational Requirements: The facility maintains an approved fire clearance and conduct regular fire/earthquake drills. Staff have proper training to meet the needs of the clients in care. Facility has an outdoor shaded activity area furnished for outdoor use.
(Continued on 809-C)

SUPERVISORS NAME: David Sicairos
LICENSING EVALUATOR NAME: Tena Herrera
LICENSING EVALUATOR SIGNATURE:	DATE: 10/29/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/29/2023

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 10/29/2023 12:23 PM - It Cannot Be Edited

Created By: Tena Herrera On 10/29/2023 at 12:02 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: DOWNEY HOME	FACILITY NUMBER: 198602394
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 10/29/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

80075(k)(1)

Health-Related Services

(k) The following requirements shall apply to medications which are centrally stored: (1) Medication shall be kept in a safe and locked place that is not accessible to persons other than employees responsible for the supervision of the centrally stored medication. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation, the licensee did not comply with the section cited above as during tour LPA observed the medication closet to be unlocked making medication accessible to clients, which poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 11/14/2023
	Plan of Correction
1 2 3 4	Note: House Manager locked medication closet immediatly once observed it was unlocked during visit Administratior to conduct an in house-training to all staff that assist with medication management/administration to ensure that medication is being properly managed at facility and turn in training log and training materials to LPA by 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:

David Sicairos

LICENSING EVALUATOR NAME:

Tena Herrera

LICENSING EVALUATOR SIGNATURE:

DATE: 10/29/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/29/2023

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
GREATER LA AC/SC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754

FACILITY NAME: DOWNEY HOME	FACILITY NUMBER: 198602394
	VISIT DATE: 10/29/2023

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Staffing: There appears to be sufficient staffing at all times in the facility. With night staff that is trained and able to assist in care and supervision of the clients in the case of an emergency.
Personnel Records-Training: Staff files are maintained in the staff office. LPA reviewed 5 staff files during today’s visit with no issues. Each file reviewed have criminal record clearance, current First Aid/CPR/AED/CPI and sufficient on-going training. Administrator Beatriz Milian-Torres certificate expired on 09/26/23 and was able to show proof of pending renewal.
Client Rights-Information: The facility does not have any clients that require postural supports. Facility provides internet and telephone landline for the clients.
Client Records-Incident Reports: Client files are maintained in the staff office and have the following documents in their files - Admission Agreements, Identification & Emergency Information, current Physician's Report, Pre-admission appraisal/Appraisal Needs & Services Plan.
Food Service: The kitchen was observed for the ability to prepare and serve food. LPA observed an appropriate food supply of two (2) days of perishables and one week (7 days) of non-perishables.
Health Related Service: Staff designated to administer medication has the proper annual training on file. Medication is properly labeled and are centrally stored in a closet and are in their original containers. During tour LPA observed medication closet to be unlocked, details will be cited on 809D page. LPA reviewed 4 clients medications and there were no issues observed.
Incidental Medical & Dental: All training is documented in the facility personnel files. Staff performance is reviewed annually and documentation is maintained in the personnel files.
Disaster Preparedness: The facility has an Emergency Disaster Plan with contact numbers and at least 2 relocation sites. Facility maintains documentation of the required emergency drills. The last Fire/Emergency Drill was conducted on 07/26/23.
Emergency Intervention: Clients at this facility do not have restraints nor do they require the use de-escalation techniques.

LPA conducted 3 staff interviews and 4 client interviews during visit.

Per California Code of Regulations, Title 22, and California Health and Safety Code, deficiencies observed during today’s visit are documented on the 809(D).

Exit interview was held and a copy of the report was provided to Administrator Beatriz Milian-Torres.

SUPERVISORS NAME: David Sicairos
LICENSING EVALUATOR NAME: Tena Herrera
LICENSING EVALUATOR SIGNATURE:	DATE: 10/29/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/29/2023

LIC809 (FAS) - (06/04)

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