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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198602548
Report Date: 09/29/2021
Date Signed: 09/29/2021 12:49:25 PM

Document Has Been Signed on 09/29/2021 12:49 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 - HONDOFACILITY NUMBER:
198602548
ADMINISTRATOR:LASHON JOHNSONFACILITY TYPE:
735
ADDRESS:7716 HONDO STTELEPHONE:
(562) 291-1549
CITY:DOWNEYSTATE: CAZIP CODE:
90242
CAPACITY: 4CENSUS: 4DATE:
09/29/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:45 AM
MET WITH:Lashon Johnson, administratorTIME COMPLETED:
01:00 PM
NARRATIVE
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Licensing Program Analyst (LPA) Spencer conducted an unannounced annual inspection focusing on the Infection Control Domain. LPA Spencer was greeted by administrator Lashon Johnson and discussed the purpose of today's visit. This single-story home contains four (4) bedrooms, two (2) bathrooms, living room, kitchen, dining area, backyard, and detached garage.
The following was observed/inspected:
  • The facility had a universal entrance screening area including a thermometer, PPE, and sign-in sheet.
  • COVID-19 signage was placed in several areas of the facility but was missing upon entry.
  • Facility maintained a 30-day supply of PPE.
  • There was a sufficient supply of 2-day perishables and 7-day supply of non-perishable foods.
  • Cleaning solutions and sharps were not locked up. At 10:20 a.m., LPA observed chemical solutions/detergents and sharps were placed in an unlocked drawer. Staff locked it at 10:22 a.m.
  • Water temperature was measured and were within the required 105-120 degrees F.
  • Each room contained required furniture including bed, dresser, night stand, lamp and chair.
  • Each bed contained all of the required linen including mattress cover, fitted sheet, flat sheet, blanket and comforter.
  • Bathrooms contained hygiene supplies including liquid soap, paper towels, and toilet paper.
  • Medications were locked, centrally stored, and given as prescribed. 30-day supply was maintained.
  • Staff wore face masks consistently throughout the shift and group activities were spaced to encourage physical distancing.
  • Smoke detectors/carbon monoxide detectors were present and operable.
  • A fire extinguisher was observed to be fully charged and last serviced November 2020.
  • Client files were inspected and emergency contact information and physician's reports were up-to-date.
  • All staff files were inspected and contained required health screenings, criminal record clearances, and training certificates. Administrator certificate expires 5/2022.
Pursuant to Title 22, a deficiency was cited on attached 809D. An exit interview was conducted and a copy of this report was provided to the administrator.
SUPERVISORS NAME: Christine Yee
LICENSING EVALUATOR NAME: LaJean Nicole Spencer
LICENSING EVALUATOR SIGNATURE: DATE: 09/29/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/29/2021
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 09/29/2021 12:49 PM - It Cannot Be Edited


Created By: LaJean Nicole Spencer On 09/29/2021 at 12:34 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 - HONDO
FACILITY NUMBER: 198602548

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/29/2021

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
80087(g)
Building and Grounds
(g) Disinfectants, cleaning solutions, poisons, firearms and other items that could pose a danger if readily available to clients shall be stored where inaccessible to clients.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, the licensee did not comply with the section cited above due to cleaning solutions, detergents, and sharps being unlocked during the observation, which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 09/30/2021
Plan of Correction
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The staff immediately locked the items to make them inaccessible. In addition, the administrator will provide in-service training to staff regarding locking up items at all times and will post a sign near the drawer to ensure that it remains locked. Administrator will send a copy of the training logs and sign posted by POC due date.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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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:Christine Yee
LICENSING EVALUATOR NAME:LaJean Nicole Spencer
LICENSING EVALUATOR SIGNATURE:
DATE: 09/29/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/29/2021


LIC809 (FAS) - (06/04)
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