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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198602417
Report Date: 12/04/2023
Date Signed: 12/04/2023 12:07:06 PM


Document Has Been Signed on 12/04/2023 12:07 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:MANHATTAN PLACEFACILITY NUMBER:
198602417
ADMINISTRATOR:CANDICE P. WATERSFACILITY TYPE:
735
ADDRESS:10640 SOUTH MANHATTAN PLACETELEPHONE:
(323) 491-6572
CITY:LOS ANGELESSTATE: CAZIP CODE:
90047
CAPACITY:4CENSUS: 3DATE:
12/04/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
08:00 AM
MET WITH:LUTHER WATERSTIME COMPLETED:
12:30 PM
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On 12/04/2023 Licensing Program Analyst Antonine Richard conducted an unannounced required annual visit using the Care Inspection Tool. LPA was properly screened for COVID-19 symptoms and temperature was checked.

LPA Richard met with staff DeJuan Cato and Licensee Luther Waters. LPA Richard informed staff that the purpose of today's visit is to conduct an annual inspection of the facility, review the physical plant, medications, food service, staff, and client records, and verify that the administrator is present at the property 20+ hours per week. LPA Richard verified all current staff fingerprints cleared/associated with the facility. The facility annual fees are current. There are currently three (3) South Central Los Angeles Regional Center (SCLARC) consumers in placement. LPA verified that the facility has an approved mitigation plan report.

DeJuan Cato and LPA Richard made a complete tour of the facility. The facility is a single-story family home located in a residential neighborhood. The facility consisted of the following: Living room, dining room, kitchen, 3 bedrooms, 1 bathroom, laundry room, detached garage, shaded area, and indoor/outdoor activity areas. Bedrooms #1 thru #3 are designated as the client's bedrooms.

See continued LIC 809-C on page #2
SUPERVISOR'S NAME: Ulysses CoronelTELEPHONE: (323) 981-1755
LICENSING EVALUATOR NAME: Antonine RichardTELEPHONE: (323) 981-1755
LICENSING EVALUATOR SIGNATURE:
DATE: 12/01/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/01/2023
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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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: MANHATTAN PLACE
FACILITY NUMBER: 198602417
VISIT DATE: 12/04/2023
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Continued LIC 809-C page #2

Documents are posted as mandated on the wall in the facility laundry room on the bulletin boards. The following Title 22 regulated areas were audited and found to be in compliance: Bedrooms contain the required furniture. The client’s bedrooms were inspected for safety, privacy, and comfort. The living areas are clean, bathrooms are clean and operational. First aid kit is fully stocked with manual.

The hot water temperature tested 109.6F degrees Fahrenheit. Working telephone, smoke and carbon monoxide detectors were in compliance, the fire extinguisher is fully charged, medications were centrally stored and properly locked in the dining area cabinet and records are current, ample supply of perishable and nonperishable food, adequate lights and linen supply, fire/emergency drill conducted on 11/13/2023. No firearms on the premises, the client's bedroom windows have no sliding window lock with thumbscrews, all exit doors were in compliance, covered trash cans, and no bodies of water were present. Hazardous items are inaccessible to clients, the yard is free of debris and hazards.

The Administrator Certificate is current and expires 05/31/2024. Staff was given training on dependent adult and elder abuse reporting.


There were no deficiencies cited. Exit interview conducted a copy of the report was provided to administrator Luther Waters
SUPERVISOR'S NAME: Ulysses CoronelTELEPHONE: (323) 981-1755
LICENSING EVALUATOR NAME: Antonine RichardTELEPHONE: (323) 981-1755
LICENSING EVALUATOR SIGNATURE:

DATE: 12/04/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/04/2023
LIC809 (FAS) - (06/04)
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