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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198602535
Report Date: 04/05/2024
Date Signed: 04/05/2024 05:11:15 PM

Document Has Been Signed on 04/05/2024 05:11 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, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245
FACILITY NAME:FRIENDS UNITEDFACILITY NUMBER:
198602535
ADMINISTRATOR/
DIRECTOR:		SUDECK, ELIZABETHFACILITY TYPE:
735
ADDRESS:12245 RAMONA AVETELEPHONE:
(310) 679-5564
CITY:HAWTHORNESTATE: CAZIP CODE:
90250
CAPACITY: 6CENSUS: 4DATE:
04/05/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
02:40 PM
MET WITH:Maria Colin, House ManagerTIME VISIT/
INSPECTION COMPLETED:
05:15 PM
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On 04/05/2024 at 2:40 pm Licensing Program Analyst (LPA) David España conducted an unannounced Required-1-year annual visit. Upon arrival at the facility, LPA España conducted a risk assessment at the front door. Based on the assessment, the facility is clear of Covid-19 infection (No COVID-19 cases). LPA verified that the facility has an approved mitigation plan report. LPA was granted access and allowed to enter the facility to conduct the inspection.

On today's visit LPA met with facility Maria Colin, House Manager. Currently there are 4 residents living at the home, that were attending present during the time of visit. The home is licensed to serve 6 ambulatory clients ages 18 to 59, with developmental disability. The facility is a single-story home in a residential neighborhood. The facility consists of 3 client bedrooms, 2 bathrooms, living room, dining room, kitchen, office, outdoor patio/backyard, and garage/storage room. LPA and House Manager Colin toured the inside and outside grounds of the facility. The outside patio is accessible to clients. There are two seating areas, that have tables and chairs. One of the areas has a canopy to provide shade. There were no bodies of water observed. LPA observed all exits and walkways around the home to be clean, clear, and free of debris and hazards. Continued on LIC809-C

SUPERVISORS NAME: Stephanie Cifuentes
LICENSING EVALUATOR NAME: David Espana
LICENSING EVALUATOR SIGNATURE: DATE: 04/05/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/05/2024
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, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245
FACILITY NAME: FRIENDS UNITED
FACILITY NUMBER: 198602535
VISIT DATE: 04/05/2024
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LPA inspected all client bedrooms, observing them to be clean and in good repair. All rooms had the required furniture, including bed, dresser, night stand, chairs, and storage space for personal belongings. All beds had the required linens including mattress pad, fitted sheets, blankets, comforter, and pillow. All bedrooms were observed to have ample lighting. In the hall closet, LPA observed an ample supply of hygiene products for residents, including shampoo, body wash, lotion, toothpaste, mouth wash, perfume, etc. Additionally in the closet were incontinence care products for residents. LPA observed a supply of PPEs. There were also a supply of markers, notepads, and pens. In the hall cupboard, LPA observed an ample supply of sheets, blankets, comforters, pillows, and towels. LPA toured both bathrooms. LPA found bathrooms to be within Title 22 regulations. The bathroom fixtures were clean, in good repair, and working properly. All grab bars were securely attached, and all showers had a non-skid mat. LPA observed ample lighting in both bathrooms. The water temperature measured within Title 22 regulations. LPA toured the kitchen and found it to be clean and in good repair. LPA observed all appliances to be working properly. LPA observed all cutleries, pots, and pans to be in good repair. LPA observed a 2-day supply of perishable foods and a 7-day supply of non-perishable foods. All cleaning supplies are secured in a locked cabinet in the laundry area and are inaccessible to residents. All knives and other sharps are secured in a locked cabinet in the laundry area and are inaccessible to clients. The water temperature measured within Title 22 regulations. Continued on LIC809-C
SUPERVISORS NAME: Stephanie Cifuentes
LICENSING EVALUATOR NAME: David Espana
LICENSING EVALUATOR SIGNATURE:

DATE: 04/05/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/05/2024
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, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245
FACILITY NAME: FRIENDS UNITED
FACILITY NUMBER: 198602535
VISIT DATE: 04/05/2024
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LPA interviewed 3 staff. LPA was able to interview all residents.

There were no deficiencies cited during today’s visit.

An exit interview was conducted with Maria Colin, and a copy of this report was provided.
SUPERVISORS NAME: Stephanie Cifuentes
LICENSING EVALUATOR NAME: David Espana
LICENSING EVALUATOR SIGNATURE:

DATE: 04/05/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/05/2024
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, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245
FACILITY NAME: FRIENDS UNITED
FACILITY NUMBER: 198602535
VISIT DATE: 04/05/2024
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In the dining room, LPA observed a large rectangular table and chairs enough to accommodate all residents. In the living room, LPA observed a couch and two chairs to accommodate all residents comfortably. In a cabinet, LPA observed activities, games, crafts, and coloring books available for residents use. All rooms were observed to be clean and in good repair. All rooms were observed to have ample lighting. All halls and walkways were observed to be clean, clear, and free of obstructions and hazards. Smoke detectors and carbon monoxide detectors were tested and fully operable. LPA observed a fully charged fire extinguisher, in the dining room, last serviced on June 28, 2023. The last emergency drill was conducted on 01/15/2024. LPA reviewed the facilities emergency disaster plan that was posted. LPA inspected the First Aid kit and found it contained the required items and a manual. All required documents are posted. LPA reviewed centrally stored medications for Client #1 and Client #2 (C1-C2) residents. LPA observed all medications to be in their original containers. LPA matched all medications to the MARs. All medications are secured in a cabinet in the laundry area and are inaccessible to residents. LPA reviewed all Four (4) resident files and found they contained the required documents. LPA reviewed the Administrators and Five (5) staff files and found they contained the required documents, certification, and training. LPA reviewed the client P&I records, Plan of Operation, and licensing reports for the past 12 months. LPA received a copy of the facilities Admission Policies, and Surety Bond. LPA has pictures of the facilities floor plan, register of clients, personnel report, Emergency Disaster Plan, License, Personal Rights, activity schedule, meal menu, and Fire Clearance. LIC809-C
SUPERVISORS NAME: Stephanie Cifuentes
LICENSING EVALUATOR NAME: David Espana
LICENSING EVALUATOR SIGNATURE:

DATE: 04/05/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/05/2024
LIC809 (FAS) - (06/04)
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