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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198602617
Report Date: 03/20/2025
Date Signed: 03/20/2025 04:46:55 PM

Document Has Been Signed on 03/20/2025 04:46 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 HOUSEFACILITY NUMBER:
198602617
ADMINISTRATOR/
DIRECTOR:		OROSZ, TAMIFACILITY TYPE:
735
ADDRESS:18819 CRANBROOK AVENUETELEPHONE:
(310) 516-8134
CITY:TORRANCESTATE: CAZIP CODE:
90504
CAPACITY: 4CENSUS: 4DATE:
03/20/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:15 PM
MET WITH:Maria DiazTIME VISIT/
INSPECTION COMPLETED:
05:00 PM
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On 03/20/25, Licensing Program Analysts (LPA), Wendy Gibbs, conducted an unannounced annual required visit using the CARE Inspection Tool. LPA met with House Manager, Maria Diaz, 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 were four (4) clients present.
Structure/Physical Plant The facility is a single-story home located in a residential neighborhood. The facility consists of (4) resident bedrooms, (2) resident bathrooms, living room, dining area, staff office area, kitchen, laundry area, attached garage, and a backyard with a table and chairs. LPA observed all walkways around the facility were clean, clear, and free of debris, obstruction, and hazards. LPA did not observe any bodies of water on the premises.
Bedrooms LPA inspected all Client bedrooms. LPA observed the rooms to be clean and in good repair. LPA observed all rooms have the required items including a bed, dresser, nightstand, chair, storage space for personal belongings, and ample lighting. LPA observed the beds have the required bedding including a mattress cover, fitted sheets, blankets, comforter, and pillows. LPA observed an ample supply of linens in good repair.
SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Wendy Gibbs
LICENSING EVALUATOR SIGNATURE: DATE: 03/20/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/20/2025
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: 03/20/2025
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Bathrooms All bathrooms were observed to be within Title 22 regulation and are operable. Showers were observed free of mold/mildew and had nonskid mats. LPA observed an ample supply of toiletries for clients. The water temperatures measured 105.1-degrees and 106.7-degrees Fahrenheit.
Kitchen LPA observed the kitchen to be clean and sanitary. All appliances are operational and in good repair. LPAs observed an ample supply of dishware, cookware, and cutleries. LPA observed a 3-day supply of perishable foods and a 7-day supply of non-perishable foods properly packaged, stored, and labeled. All sharps were observed secured in a locked cabinet in the hallway and are inaccessible to clients. The water temperature measured 106.5-degrees Fahrenheit.
Common Rooms LPA observed the living room has two couches to accommodate clients. The dining room and kitchen has tables and chairs to accommodate all clients. LPAs observed games, puzzles, reading material and activities in a bookcase in the dining room and client rooms. The facility was observed to be properly furnished during time of visit. All walkways and hallways were observed clean, clear, free of hazards and obstructions. All rooms have ample lighting. The facility was maintained at a comfortable temperature.
File Review LPA reviewed three (3) resident files and observed them to have the required documents. LPA reviewed the Administrator and three (3) staff files and observed them to have the required training's, certifications, and documents. LPA reviewed the residents P & I document for the past two (2) months. The facility has a Surety bond through Nation Wide. LPA observed the Licensing Fees are current.
SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Wendy Gibbs
LICENSING EVALUATOR SIGNATURE:

DATE: 03/20/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/20/2025
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: 03/20/2025
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Medications LPA observed Centrally Stored Medications secured in a locked cabinet in the hallway and are inaccessible to clients. LPA reviewed the medications and Medication Administration Records (MAR) for three (3) clients. LPA observed three (3) out of three (3) clients MARs and medication are consistent with properly documented records.
Safety LPA 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 02/28/25. The facility disaster plan is current and in compliance with Title 22. LPA inspected the First Aid Kit and observed it had the required items and a current First Aid manual. The facility has a working landline telephone. All required posting were observed in the office area.
Infection Control LPA observed the facility has an Infection Control Plan. LPA observed infection control signs posted throughout the facility. LPA observed a sanitizing station in the living room that has a visitor logbook with temperature checks, hand sanitizer, gloves, and face masks. LPA observed an ample supply of cleaning supplies. LPA observed a 90-day supply of Personal Protective Equipment (PPE) stored in the garage.

According to the California Code of Regulations (Title 22, Division 6, Chapter 8), LPA did not observe any deficiencies therefore no citations were issued at this time.

An exit interview was conducted with House Manager, Maria Diaz and a copy of this report was provided.

SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Wendy Gibbs
LICENSING EVALUATOR SIGNATURE:

DATE: 03/20/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/20/2025
LIC809 (FAS) - (06/04)
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