198602859-1-23-2023-11-AS-MBRN-CNCU5N-20230123141700

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 198602859
Report Date: 01/23/2023
Date Signed: 01/23/2023 02:17:15 PM

Document Has Been Signed on 01/23/2023 02:17 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, 1000 CORPORATE DR #100
MONTEREY 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:	01/23/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	11:57 AM
MET WITH:	Dr. Melvora Moore Fulton		TIME COMPLETED:	02:15 PM

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On 1/13/23, Licensing Program Analyst (LPA) Martessa Brown was at the facility to conduct and unannounced required annual inspection and there was no administrator or staff there to conduct inspection.

On 1/23/23, Licensing Program Analyst (LPA) Martessa Brown, returned to the facility to continue unannounced annual visit with a primary focus on Infection Control measures using the Inspection Tools. LPA Brown was met by Dr. Melvora Moore Fulton, Licensee the purpose of today’s visit was explained. LPA conducted a risk assessment prior to entering in the facility and they are clear from Covid-19. Facility is licensed for four (4) ambulatory developmentally disabled adults between the ages of 18 to 59.

There are currently (3) South Central Regional Center Clients. Clients are ambulatory. The facility is one-story residential home consists of a living room, kitchen, dining area, two (2) bedrooms, two (2) bathrooms, attached two car garages with shaded backyard patio area. During the tour, LPA observed the facility’s infection control practices. LPA observed a sanitizing station at the facility entrance; a visitor 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. Centrally stored medications were 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. A Comfortable temperature was maintained in the facility. LPA toured the kitchen area and observed supply of perishable and a seven-day supply of non-perishable food. Knives and toxins were locked.

LIC 809-C is on the next page.

SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Martessa Brown
LICENSING EVALUATOR SIGNATURE:	DATE: 01/23/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/23/2023

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, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754

FACILITY NAME: VERNELLA TRANSITIONAL HOME 2	FACILITY NUMBER: 198602859
	VISIT DATE: 01/23/2023

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The facility has one (1) Fire Extinguisher, which was checked and found to be fully charged, 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. PA advised the Administrator to continuously monitor the Centers for Disease Control (CDC) website and Community Care Provider Informational Notices (PIN) for any updates relating to COVID-19 guidance.

No deficiencies were cited during this visit.

An exit interview was conducted, and a copy of this report was provided to Dr. Moore Fulton.

SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Martessa Brown
LICENSING EVALUATOR SIGNATURE:	DATE: 01/23/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/23/2023

LIC809 (FAS) - (06/04)

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