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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198602548
Report Date: 03/13/2023
Date Signed: 03/15/2023 09:30:49 AM

Document Has Been Signed on 03/15/2023 09:30 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
GREATER LA AC/SC, 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:
03/13/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:55 AM
MET WITH:Lashon Johnson-AdministratorTIME COMPLETED:
03:40 PM
NARRATIVE
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Licensing Program Analyst (LPA) Christine Wong conducted the unannounced Annual Inspection and met with DSP Renisha Brooks who allowed the entry of the facility. Shortly after, the administrator Lashon Johnson arrived and explained the reason of today's visit and will be using the Compliance And Regulatory Enforcement (CARE) Tools to inspect the facility. The facility is licensed for age range 18 through 59 and 4 ambulatory of which 2 may be non-ambulatory.

The following domains were reviewed during today's annual required visit which included: infection control, physical plant and environmental, operational requirements, staffing, personnel records-training, client rights- information, client records-incident reports, food service, health related services, incidental medical services, disaster preparedness and emergency intervention.

Infection Control: The facility staff are using appropriate hand hygiene and wearing gloves while assisting clients. Staff are cleaning and disinfecting at least each shift or as needed and more often for high touched surfaces. Facility has sufficient PPE supplies and has an Infection Control Plan.
Physical plant and Environmental: The facility is a single story house and located in a residential neighborhood area. The facility includes kitchen, dining area, laundry area, staff office, living room, four (4) clients bedrooms, two (2) clients bathrooms. Facility has an operable smoke detectors and carbon monoxide detectors are interconnected and they are located in each clients' room. Knives, cleaning solutions, and disinfectants are locked under the sink and kitchen drawer, making them inaccessible to clients. There are no firearms or weapons stored at the facility. The hot water temperature in the bathrooms were measured between the required range of 105-120 degrees F.

(See LIC 809C for continuation)
SUPERVISORS NAME: David Sicairos
LICENSING EVALUATOR NAME: Christine Wong
LICENSING EVALUATOR SIGNATURE: DATE: 03/13/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/13/2023
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
GREATER LA AC/SC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754
FACILITY NAME: CHOICES R US - HONDO
FACILITY NUMBER: 198602548
VISIT DATE: 03/13/2023
NARRATIVE
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Operational Requirements: The fire clearance was approved for 2 ambulatory and 2 non-ambulatory. The facility will assist with client needs according to IPP and they would provide care and supervision to clients Clients also have their right to attend activity in the community.
Staffing: There's sufficient staffing in the facility. The administrator (Lashon Johnson) certificate will be expired on 5/4/2024. Staff employed are over the age of 18 and are fingerprint cleared and associated to the facility. The night staff (S1) did not have any training about facility planned emergency procedures.
Personnel Records-Training: Staff files are maintained at the facility. All staff have an updated first aid certificate. The administrator has an updated HIV and TB training.
Client Records-Incident Reports: Client files are maintained at the facility and have the following documents in their files - Admission Agreements, IPP and updated physician report . The clients do not have the written functional capabilities assessment
Client RIGHTS INFORMATION: The facility provide internet service and at least internet access device to clients and no client need any postural support, only one (1) client is using wheelchair in the facility which documented in client's IPP.
Food Service: There are sufficient food supplies of 2-day perishable and a week of non-perishable items. The food are properly stored in the refrigerator.
Health Related Services: The medication is centrally stored and locked in the hallway closet and inaccessible to clients. All the clients medication are given according the physician direction.
Incidental Medical Services: There's one client in the facility is insulin dependent but the staff is not responsible for insulin injection, client has a licensed nurse comes twice a day for the insulin injection and blood sugar checking.
Disaster Preparedness: : The facility has an updated Emergency Disaster Plan posted with contact numbers with two alternative relocation sites. The staff does not have annual emergency and disaster training.
Emergency Intervention: It's not applicable for the facility

During the annual inspection, LPA interviewed 3 staff and 1 client due to the other two clients are non-verbal.

Deficiencies cited under California Code of Regulations, Title 22, Division 6, Chapter 1

Exit interview was conducted, Appeals Rights discussed and a copy of the report was given to the Administrator Lashon Johnson.
SUPERVISORS NAME: David Sicairos
LICENSING EVALUATOR NAME: Christine Wong
LICENSING EVALUATOR SIGNATURE:

DATE: 03/13/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/13/2023
LIC809 (FAS) - (06/04)
Page: 2 of 4
Document Has Been Signed on 03/15/2023 09:30 AM - It Cannot Be Edited


Created By: Christine Wong On 03/13/2023 at 02:22 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: 03/13/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
85065.6(b)
Night Supervision
(b) Employees providing night supervision from 10:00 p.m. to 7:00 a.m., as specified in (c) through (f) below, shall be available to assist in the care and supervision of clients in the event of an emergency, and shall have received training in the following:

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, LPA observed the night staff (S1) does not have receive the planned emergency procedure training which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 03/27/2023
Plan of Correction
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The administrator will ensure the night staff to have planned emergency procedure training and the administrator will send the training log to LPA by POC due date
Type B
Section Cited
CCR
85068.2(b)(1)(F)
Needs and Services Plan
(b) If the client is to be admitted, then prior to admission, the licensee shall complete a written Needs and Services Plan, which shall include: (1) The client's desires and background, obtained from the client, the client's family or his/her authorized representative, if any, and licensed professional, where appropriate, regarding the following: (F) The written functional capabilities assessment specified in Section 80069.2.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, LPA observed clients do not have the written functional capabilities assessment which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 03/27/2023
Plan of Correction
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The administrator will ensure to complete the functional capabilities assessment for the pre-placement and the administrator will send the functional capabiliteis assessment for C1-C3 by POC due date.
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:Christine Wong
LICENSING EVALUATOR SIGNATURE:
DATE: 03/13/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/13/2023


LIC809 (FAS) - (06/04)
Page: 4 of 4
Document Has Been Signed on 03/15/2023 09:30 AM - It Cannot Be Edited


Created By: Christine Wong On 03/13/2023 at 02:22 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: 03/13/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
HSC
1565(b)
Other Provisions
(b) If a facility employs staff, the facility shall provide training on the plan to each staff member upon hire and annually thereafter. The training shall include staff responsibilities during an emergency or disaster.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, LPA did not observe annual staff training for emergency and disaster which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 03/27/2023
Plan of Correction
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The administrator will ensure staff to have emergency or disaster training annually. The administrator will send the staff training log 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:David Sicairos
LICENSING EVALUATOR NAME:Christine Wong
LICENSING EVALUATOR SIGNATURE:
DATE: 03/13/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/13/2023


LIC809 (FAS) - (06/04)
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