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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198602535
Report Date: 03/28/2022
Date Signed: 03/29/2022 07:15:29 AM

Document Has Been Signed on 03/29/2022 07:15 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:FRIENDS UNITEDFACILITY NUMBER:
198602535
ADMINISTRATOR:SUDECK, ELIZABETHFACILITY TYPE:
735
ADDRESS:12245 RAMONA AVETELEPHONE:
(310) 679-5564
CITY:HAWTHORNESTATE: CAZIP CODE:
90250
CAPACITY: 6CENSUS: 4DATE:
03/28/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:25 PM
MET WITH:Maria ColinTIME COMPLETED:
03:25 PM
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Inspection visit at the Friends United, with emphasis on infection control. LPA Nwaokoro met with facility staff Maria Colin and explained the purpose of the visit. A risk assessment was done with Maria Colin before entering the building. The facility is licensed to serve 6 ambulatory clients ages 18 to 59, with developmental disability.

LPA and staff Maria tour of the facility. Currently the residential house has (4) ambulatory clients, and at this time (4) clients are between the ages of 18-59. As part of the inspection, LPA reviewed: 4 client service records, client P & I records, 8 personnel staff records, and 3 client medication records.

LPA and Maria Colin, Facility Manager toured the facility inside and outside grounds. The single-story residential house consisted of (3) client bedrooms, (2) bathroom, living room, dining room, kitchen, outdoor patio/ backyard, garage/ storage room. LPA inspected all client bedrooms, observing them to be clean, and in good repair. LPA observed the following during inspection of client rooms: mattresses and box springs in good condition, adequate lighting, dresser/closet, and all required bed linens. In addition, sufficient bedding, linens, and toiletries provided to clients.

LPA observed that the facility had a fully stocked bedding and towel closet. In addition, LPA observed bathrooms were found to be within Title 22 regulation. The bathroom fixtures were clean, in good repair, and working properly and included grab bars and on-slip mats. Bathroom 1 hot water temperature measured at 119.4 degrees F, and bathroom 2 hot water temperature measured at 118.8 degrees F. Perishable (7 day) and non-perishable (2 day) food supply were checked and are adequately stocked. LPA reviewed (4) client files and observed to be complete and current. Personal and Incidental funds are kept locked in a filing cabinet, ledgers appeared to be current and matching the facility's record of receipts.

Facility Evaluation Report continued on LIC 809C.

SUPERVISORS NAME: Michael Cava
LICENSING EVALUATOR NAME: Ngozi Nwaokoro
LICENSING EVALUATOR SIGNATURE: DATE: 03/28/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/28/2022
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: FRIENDS UNITED
FACILITY NUMBER: 198602535
VISIT DATE: 03/28/2022
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LPA observed the (1) fire extinguisher to be charged and accessible, emergency disaster plan was posted with required documents, (5) smoke detectors were functional and working properly, and (5) carbon monoxide detector was operable. First Aid kit is complete. All toxins and knifes are locked/secured and inaccessible to clients. Medications are centrally stored and in a locked cabinet and administered according to doctors’ orders at the time of this visit. Outside grounds were toured and no bodies of water were observed. Outside patio accessible to clients. All Exits/ Walkways around the home were free of debris and hazards.

There were no deficiencies cited during todays visit.



A copy of the LIC 809 was given to the staff Maria Colin during the exit interview.
SUPERVISORS NAME: Michael Cava
LICENSING EVALUATOR NAME: Ngozi Nwaokoro
LICENSING EVALUATOR SIGNATURE:

DATE: 03/28/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/28/2022
LIC809 (FAS) - (06/04)
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