198602859-1-25-2022-11-AS-JCAS-CAZRLH-20220125120710

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 198602859
Report Date: 01/24/2022
Date Signed: 01/25/2022 12:07:21 PM

Document Has Been Signed on 01/25/2022 12:07 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
MONTERY PARK, CA 91754

FACILITY NAME:	VERNELLA TRANSITIONAL HOME 2		FACILITY NUMBER:	198602859
ADMINISTRATOR:	RALPH E FULTON, SR		FACILITY TYPE:	735
ADDRESS:	1615 W. 166TH STREET		TELEPHONE:	(310) 387-6870
CITY:	COMPTON	STATE: CA	ZIP CODE:	90220
CAPACITY: 4		CENSUS: 3	DATE:	01/24/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	01:22 PM
MET WITH:	Dr Melvora Moore Fulton		TIME COMPLETED:	03:45 PM

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Licensing Program Analyst (LPA) Jey Cardenas conducted an unannounced required annual visit with a primary focus on Infection Control measures using the new CARE Inspection Tools. Upon arrival at the facility, LPA Cardenas met with staff Jovan Nichols; the purpose of today’s visit was explained. LPA conducted a risk assessment, based on the assessment, the facility is clear of Covid-19 infection. LPA was later met by Licensee, Dr. Melvora Moore Fulton who assisted with the visit. Facility is licensed for four (4) ambulatory developmentally disabled adults between the ages of 18 to 59.

The one story residential home consists of a living room, kitchen, dining area, two (2) bedrooms, two (2) bathrooms, attached two car garage with shaded backyard patio area.

During the tour, LPA observed the facility’s infection control practices. LPA verified that the facility has an approved mitigation plan report. LPA was properly screened for Covid-19 symptoms, temperature was checked. LPA observed a sanitizing station at the facility entrance; a visitors log with Covid-19 screening, PPE supplies are readily available with an additional 30 day supply of PPE in stock. Sufficient paper, cleaning, and disinfecting supplies were observed. LPA observed all staff wear a face covering. LPA observed required postings throughout the facility. CCLD PINS were readily available to staff and clients.

All rooms were inspected, there is one (1) shared and one (1) private bedroom. Beds in shared bedroom are separated apart for social distancing. Beds and bedding supplies were in good condition, adequate lighting provided, storage for client personal belongings was observed.

client bathrooms were checked, sufficient liquid soap and paper towels were observed. Toilets and water faucets worked properly, the water temperature measured at 105.4 degrees F in client bathroom. Comfortable temperature was maintained in the facility.

LPA toured the kitchen area and observed a two-day supply of perishable and a seven-day supply of non-perishable food. Knives and toxins were locked. Centrally stored medications were observed stored in

SUPERVISORS NAME: Angela J Kendrick
LICENSING EVALUATOR NAME: Jey Cardenas
LICENSING EVALUATOR SIGNATURE:	DATE: 01/24/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/24/2022

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
MONTERY PARK, CA 91754

FACILITY NAME: VERNELLA TRANSITIONAL HOME 2	FACILITY NUMBER: 198602859
	VISIT DATE: 01/24/2022

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their originally received containers and kept safe and locked and inaccessible to clients in care. The facility has one (1) Fire Extinguisher, which was checked and found to be fully charged, accessible, and purchased receipt was dated 08/04/2021. The First Aid kit was available and fully stocked. There are no security bars or weapons on the premises. Smoke detectors are hardwired and battery operated, and one (1) carbon monoxide detector is located in the hallway.

Outside grounds were toured, and no bodies of water were observed. Walkways around the home were clear of hazards. Common areas were clean and clear of hazards. No bodies of water present.

Technical Advisories issued:

1. N95 mask Fit testing for all staff.

2. Ensure visitors policy is posted at the facility entrance.

No deficiencies were cited during this visit. An exit interview was conducted, and a copy of this report LIC809 and LIC809C was provided to facility representative, Dr. Moore Fulton.

SUPERVISORS NAME: Angela J Kendrick
LICENSING EVALUATOR NAME: Jey Cardenas
LICENSING EVALUATOR SIGNATURE:	DATE: 01/24/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/24/2022

LIC809 (FAS) - (06/04)

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