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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198602614
Report Date: 02/23/2022
Date Signed: 02/23/2022 06:47:46 PM

Document Has Been Signed on 02/23/2022 06:47 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 DR #100
MONTEREY PARK, CA 91754
FACILITY NAME:PRIME OPTIONS CARE INCFACILITY NUMBER:
198602614
ADMINISTRATOR:NGUYEN, HAIFACILITY TYPE:
735
ADDRESS:2041 W 162ND STTELEPHONE:
(310) 678-6784
CITY:TORRANCESTATE: CAZIP CODE:
90504
CAPACITY: 5CENSUS: 4DATE:
02/23/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:25 PM
MET WITH:Licensee - Hai Nuygen/Administrator LInda WhitfordTIME COMPLETED:
03:30 PM
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On 02/23/2022, Licensing Program Analyst (LPA) Don Senaha conducted an unannounced annual required visit with a primary focus on Infection Control measures using the new CARE Inspection Tool. LPA met with Licensee Hai Nguyen and Administrator Linda Whitford and explained the purpose of today’s visit. The facility is licensed to operate for five (5) ambulatory developmentally disabled clients of between the ages of 18 through 59 of which one (1) may be non-ambulatory.

The facility is a single-story structure located in a residential neighborhood. It consists of the following: four (4) client rooms, one (1) office space, three (3) bathrooms, two (2) living areas, one (1) dining area and kitchen. There is an outside covered patio area with ample seating. The laundry area is in the garage. The garage is attached with access from the front of the garage or a side door. Garage includes an additional refrigerator/freezer and is used for storage.

LPA and Licensee toured the physical plant and was later joined by Administrator Linda Whitford. There were no bodies of water or obstructions on the premises. All rooms were inspected. Beds and bedding supplies were in good condition, adequate lighting provided, storage for client personal belongings was observed. Bed linens, comforters, and bath towels were adequately stocked at the time of visit. Bathrooms were found to be within Title 22 regulations and were clean and operational. The water temperature measured between 106.7 F to 119.6 F in the bathrooms and kitchen sink. A comfortable temperature was maintained in the facility.


Evaluation Report Continues on LIC 809-C
SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Don Senaha
LICENSING EVALUATOR SIGNATURE: DATE: 02/23/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/23/2022
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: PRIME OPTIONS CARE INC
FACILITY NUMBER: 198602614
VISIT DATE: 02/23/2022
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LPA observed the facility to be sanitary and appropriately furnished at the time of visit. Storage areas for personal hygiene, cleaning supplies, toxins, and sharps objects were stored and not accessible to clients. The kitchen was inspected and there is sufficient perishable and non-perishable food available maintained properly. There is one (1) fire extinguisher fully charge located in the kitchen. Smoke detectors and carbon monoxide were operable and in working condition. A reviewed of Medication Records Administration (MAR) was observed to be maintained in order and accurate.

During the visit, LPA observed the facility infection control practices. LPA observed screening protocols for visitors, staff, and residents with hand sanitizer. LPA observed the facility has a 30-day supply of Personal Protective Equipment (PPE). All mandated inspection control posters were posted.

No deficiencies were cited during this inspection visit.

An exit interview was conducted and a copy of this report was provided to Administrator Linda Whitford.
SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Don Senaha
LICENSING EVALUATOR SIGNATURE:

DATE: 02/23/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/23/2022
LIC809 (FAS) - (06/04)
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