<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198602548
Report Date: 11/04/2024
Date Signed: 11/04/2024 01:12:11 PM

Document Has Been Signed on 11/04/2024 01:12 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
MONTEREY PARK ASC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754
FACILITY NAME:CHOICES R US - HONDOFACILITY NUMBER:
198602548
ADMINISTRATOR/
DIRECTOR:		LASHON JOHNSONFACILITY TYPE:
735
ADDRESS:7716 HONDO STTELEPHONE:
(562) 291-1549
CITY:DOWNEYSTATE: CAZIP CODE:
90242
CAPACITY: 4CENSUS: 4DATE:
11/04/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:06 AM
MET WITH: Administrator Lashon A. Johnson TIME VISIT/
INSPECTION COMPLETED:
01:15 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
Licensing Program Analyst (LPA) Tyler Reyes conducted the unannounced Annual Inspection and met with Administrator Lashon A. Johnson and explained the reason of today’s visit.

For today's inspection LPA used 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 facility has (4) bedrooms and (2) bathrooms, backyard, and a detached garage.

The following was observed, reviewed, and inspected:

LPA reviewed all (4) clients files and reviewed Administrator's and (2) staff files. Staff were cleared, CPR/First Aid certified and had all documentation's in place. Clients had appropriate documentation's and Physician Report w/ TB.

LPA reviewed (4) client medications and Medication Administration Record, all medications had labels, in place and no deficiencies were observed. LPA observed with Administrator Johnson in area accessible to clients in the office/laundry area was medications. In an open box covered by a staff's sweater was client #1 (C1) prescribed Thick-It Powder medication. Underneath that shelf in an open box was C2's Lorazepam 0.5 MG Tablet medication.

(Continued LIC 809-c)

SUPERVISORS NAME: Fernando Fierros
LICENSING EVALUATOR NAME: Tyler Reyes
LICENSING EVALUATOR SIGNATURE: DATE: 11/04/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/04/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 5
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK ASC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754
FACILITY NAME: CHOICES R US - HONDO
FACILITY NUMBER: 198602548
VISIT DATE: 11/04/2024
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
LPA and Administrator Johnson toured/inspected the physical plant: all bedrooms are designated for clients as private bedrooms, no staff bedroom, all bedrooms contain the required about of furniture and lighting fixtures, mattresses and box springs are in good repair, beds have the required amount of linen. LPA observed with Administrator Johnson in (2) two of the client’s bedrooms with half bed rails. Neither client #1 (C1) or C2 had a physician’s order on file for bed rails.

Restroom #1 hot water temperature was observed at 111.5 degrees F and restroom #2 LPA was unable to measure the water temperature. LPA observed Administrator Johnson unsuccessful in using the hot water knob. Administrator Johnson stated the valve underneath the sink was turned off because the hot water knob is broken.

Kitchen had supply of perishable and nonperishable foods, refrigerator, freezer, microwave and counter tops are clean, ample supply of dishes, cups, glasses and utensils.

Fully stocked first aid kit with manual.

LPA observed with Administrator Johnson in the backyard (2) couches and (2) recliner chairs. Administrator Johnson states she plans on getting these items of furniture disposed.

Emergency Disaster Drill conducted on 11/1/2024- Fire and Earthquake Drill

Administrator Johnson’s Adult Residential Facility Certificate Expires: May 4th, 2026

Exit interviewed conducted with Administrator Johnson and a copy of this report was provided with appeal rights.

SUPERVISORS NAME: Fernando Fierros
LICENSING EVALUATOR NAME: Tyler Reyes
LICENSING EVALUATOR SIGNATURE:

DATE: 11/04/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/04/2024
LIC809 (FAS) - (06/04)
Page: 2 of 5
Document Has Been Signed on 11/04/2024 01:12 PM - It Cannot Be Edited


Created By: Tyler Reyes On 11/04/2024 at 12:43 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: 11/04/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
80075(k)(1)
Health-Related Services
(k) The following requirements shall apply to medications which are centrally stored: (1) Medication shall be kept in a safe and locked place that is not accessible to persons other than employees responsible for the supervision of the centrally stored medication.

This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on observations , the licensee did not comply with the section cited above LPA observed with Administrator Johnson in area accessible to clients in the office/laundry area was medications. In an open box covered by a staff's sweater was client #1 (C1) prescribed Thick-It Powder medication. Underneath that shelf in an open box was C2's Lorazepam 0.5 MG Tablet which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 11/05/2024
Plan of Correction
1
2
3
4
Licensee will ensure that all medication is kept safe and in a locked place that is not accessible to person other than employees responsible. Licensee will provide in-service training for all staff on the ensuring medication is secured.
The in-service training will include list of attendees names and attendees signatures. Licensee will provide proof of in-service training to CCL by POC Due Date.
Section Cited
Deficient Practice Statement
1
2
3
4
POC Due Date:
Plan of Correction
1
2
3
4
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:Fernando Fierros
LICENSING EVALUATOR NAME:Tyler Reyes
LICENSING EVALUATOR SIGNATURE:
DATE: 11/04/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/04/2024


LIC809 (FAS) - (06/04)
Page: 3 of 5
Document Has Been Signed on 11/04/2024 01:12 PM - It Cannot Be Edited


Created By: Tyler Reyes On 11/04/2024 at 12:43 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: 11/04/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
80087(c)
Building and Grounds
(c) All outdoor and indoor passageways, stairways, inclines, ramps, open porches and other areas of potential hazard shall be kept free of obstruction.

This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on observations and interviews, the licensee did not comply with the section cited above LPA observed with Administrator Johnson in the backyard (2) couches and (2) recliner chairs. Administrator Johnson states she plans on getting these items of furniture disposed which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 11/11/2024
Plan of Correction
1
2
3
4
Licensee will provide pictures showing the items of furniture from the backyard were removed to CCL by POC Due Date.
Type B
Section Cited
CCR
80088(e)(3)
Fixtures, Furniture, Equipment, and Supplies
(e) Faucets used by clients for personal care such as shaving and grooming shall deliver hot water. (3) All toilets, handwashing and bathing facilities shall be maintained in safe and sanitary operating condition. Additional equipment, aids, and/or conveniences shall be provided in facilities accommodating physically handicapped clients who need such items.

This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on observation and interview, the licensee did not comply with the section cited above LPA was unable to measure the water temperature in restroom #2. LPA observed Administrator Johnson unsuccessful in using the hot water knob. Administrator Johnson stated the valve underneath the sink was turned off because the hot water knob is broken which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 11/11/2024
Plan of Correction
1
2
3
4
Administrator will provide proof of fixed sink and will develop a water log and record water temeratures every 24 hrs for the next 5 calendar days. Proof must be submitted to CCL 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:Fernando Fierros
LICENSING EVALUATOR NAME:Tyler Reyes
LICENSING EVALUATOR SIGNATURE:
DATE: 11/04/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/04/2024


LIC809 (FAS) - (06/04)
Page: 4 of 5
Document Has Been Signed on 11/04/2024 01:12 PM - It Cannot Be Edited


Created By: Tyler Reyes On 11/04/2024 at 12:43 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: 11/04/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
80072(a)(8)(B)
Personal Rights
(B) A written order from the client's physician indicating the need for the postural support shall be maintained in the client's record. The licensing agency shall be authorized to require additional documentation if needed to verify the order.

This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on observation , the licensee did not comply with the section cited above LPA observed with Administrator Johnson in (2) two of the client’s bedrooms with half bed rails. Neither client #1 (C1) or C2 had a physician’s order on file for bed rails which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 11/11/2024
Plan of Correction
1
2
3
4
Licensee agrees to submit a physician's order for C1 & C2's bed rails. The order will specify the length of the bed rail.
Section Cited
Deficient Practice Statement
1
2
3
4
POC Due Date:
Plan of Correction
1
2
3
4
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:Fernando Fierros
LICENSING EVALUATOR NAME:Tyler Reyes
LICENSING EVALUATOR SIGNATURE:
DATE: 11/04/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/04/2024


LIC809 (FAS) - (06/04)
Page: 5 of 5