198602617-3-14-2024-11-AS-WGIS-D3CURY-20240314154932

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 198602617
Report Date: 03/14/2024
Date Signed: 03/14/2024 03:50:08 PM

Document Has Been Signed on 03/14/2024 03:50 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, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754

FACILITY NAME:	CRANBROOK HOUSE		FACILITY NUMBER:	198602617
ADMINISTRATOR:	OROSZ, TAMI		FACILITY TYPE:	735
ADDRESS:	18819 CRANBROOK AVENUE		TELEPHONE:	(310) 516-8134
CITY:	TORRANCE	STATE: CA	ZIP CODE:	90504
CAPACITY: 4		CENSUS: 4	DATE:	03/14/2024
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	08:50 AM
MET WITH:	Maria "Elva" Aguirre		TIME COMPLETED:	03:45 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	On 03/14/24, Licensing Program Analysts (LPA), Wendy Gibbs and Darneisha Cross, conducted an unannounced annual required visit using the CARE Inspection Tool. LPAs met with Direct Support Professional, Maria ‘Elva’ Aguirre and were later joined by Administrator Tami Orosz and the purpose of today’s visit was explained. The facility is licensed to serve four (4) ambulatory adults ages 18 through 59. Clients are Harbor Regional Center clients. During the time of visit there was 1 client present, and 3 clients came home from day program later in the day. Structure/Physical Plant The facility is a single-story home located in a residential neighborhood and consists of (4) resident bedrooms, (2) resident bathrooms, living room, dining area, staff working area, kitchen, laundry area, attached garage, and a backyard with a shaded seating area. LPAs observed all walkways on the side of the home were clean, clear, and free of debris, obstruction, and hazards. LPAs did not observe any bodies of water on the premises. Bedrooms All client rooms were checked, mattresses and box springs were in good condition, adequate lighting, plenty of dresser and closet space was observed, walls and floors were clean and in good repair, bed linens, comforters and bath towels were fully stocked. LPAs observed an ample supply of sheets, blankets, and towels located in the cabinet in the hallway.

SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Wendy Gibbs
LICENSING EVALUATOR SIGNATURE:	DATE: 03/14/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/14/2024

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, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754

FACILITY NAME: CRANBROOK HOUSE	FACILITY NUMBER: 198602617
	VISIT DATE: 03/14/2024

NARRATIVE

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Bathrooms Bathrooms were found to be within Title 22 regulation, toilets and water faucets worked properly, shower was free of mold/mildew, there is adequate lighting, and sufficient toiletries accessible to residents. LPAs observed a nonskid mat. The water temperature properly measured between 105-120 Fahrenheit.
Kitchen LPAs observed all appliances in good repair. LPAs observed an ample supply of dishware, cookware, and cutlery. LPAs observed a 3-day supply of perishable foods and a 7-day supply of non-perishable foods. All foods were properly stored, labelled, and dated. All sharps were observed secured in a locked cabinet in the hallway and are inaccessible to clients. The water temperature measured 108.5-degrees Fahrenheit.
Common Rooms LPAs observed ample seating in the living room for residents. The dining room has tables and chairs to accommodate all residents. LPAs observed games, puzzles, and activities in a bookcase in the dining room. All walkways and hallways were observed clean, clear, free of hazards and obstructions, and had ample lighting.
File Review LPAs reviewed three (3) resident files and observed them to have the required documents. LPAs reviewed the Administrator and three (3) staff files and observed them to have the required training's, certifications, and documents. LPAs reviewed the residents P & I documents for the past two (2) months. The facility has a Surety bond through Nation Wide. LPAs observed the Licensing Fees are up to date.

SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Wendy Gibbs
LICENSING EVALUATOR SIGNATURE:	DATE: 03/14/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/14/2024

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, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754

FACILITY NAME: CRANBROOK HOUSE	FACILITY NUMBER: 198602617
	VISIT DATE: 03/14/2024

NARRATIVE

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Medications LPAs observed Centrally Stored Medications secured in a locked cabinet and are inaccessible to clients. LPAs reviewed the medications and Medication Administration Records (MAR) for four (4) clients. LPAs observed clients MARs and medication are consistent with properly documented records.
Safety LPAs observed smoke detectors and carbon monoxide detector to be operable. LPAs observed two fully charged fire extinguishers in the kitchen. The last emergency drill was conducted on 02/29/24. The facility disaster plan is current and in compliance with Title 22. LPAs inspected the First Aid Kit and observed it had the required items and an up to date First Aid manual. LPAs tested the facilities landline telephone. All required posting were observed in the dining room and living room.
Infection Control LPAs observed the facility has an Infection Control Plan. LPA's observed infection control signs posted throughout the facility. LPA's observed a sanitizing station in the living room that has a visitor log book with temperature checks, hand sanitizer, gloves, and face masks. LPA's observed an ample supply of cleaning supplies. LPA observed a 90-day supply of Personal Protective Equipment (PPE) stored in the garage.
Interviews LPAs conducted two resident (2) interviews, both residents were happy with the care and services they receive. LPAs conducted two (2) Staff interviews, both staff were able to answer questions regarding client care, procedures, policy's and resident personal rights.
During today’s visit no discrepancies were observed.
An exit interview was conducted with Administrator, Tami Orosz, and a copy of this report was provided.

SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Wendy Gibbs
LICENSING EVALUATOR SIGNATURE:	DATE: 03/14/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/14/2024

LIC809 (FAS) - (06/04)

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