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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198603011
Report Date: 02/28/2024
Date Signed: 03/11/2024 04:49:50 PM

Document Has Been Signed on 03/11/2024 04:49 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, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245
FACILITY NAME:INTEGRATED TREATMENT SERVICES IIIFACILITY NUMBER:
198603011
ADMINISTRATOR:AUBRI GRIFFISFACILITY TYPE:
737
ADDRESS:15331 S AINSWORTH STTELEPHONE:
(310) 916-7200
CITY:GARDENASTATE: CAZIP CODE:
90247
CAPACITY: 3CENSUS: 3DATE:
02/28/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:15 PM
MET WITH:Aubri Griffis, AdministratorTIME COMPLETED:
03:45 PM
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On 2/28/24 at 1:15 PM, Licensing Program Analyst (LPA) Felisa Shirley conducted an unannounced annual required visit using the CARE Inspection Tool. LPA met with Aubri Griffis, Administrator and the purpose of today’s visit was explained. The facility is licensed to operate for (3) ambulatory, (developmentally disabled or Mentally Ill) adults ages 18 through 59. Currently, the home has (3) clients. The clients are Westside Regional Center clients. None the clients have Restricted Health Care Conditions, and (1) client is utilizing postural supports or protective devices (seizure helmet).

The facility is a one-story structure located in a residential neighborhood. The facility consists of (3) bedrooms, (2) bathrooms, living room, dining room, family room, kitchen, garage, back yard, patio with shaded porch and laundry room. Facility maintains all required posting throughout the facility.



LPA Shirley and Aubri walked through the kitchen and all appliances were in good working order. Knives and medications were locked and stored in the pantry in the kitchen and inaccessible to residents. LPA observed a 3-day supply of perishable and a 7-day supply of nonperishable foods. The water temperature measured 113.2 degrees Fahrenheit.

LPA observed the facility is clean, sanitary, and in good repair. Indoor and outdoor passageways, and other areas of potential hazard are free of obstructions. Facility temperature is between 68° degrees and 85° degrees. Carbon monoxide/Smoke detectors operate properly.

There are ample amounts of first-aid supplies and first-aid manual. There is working washer and dryer located in a room attached to the garage. The backyard is clean and clear of obstructions and hazards and there are no bodies of water present.

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, and a copy of this report was provided to Administrator, Aubri Griffis.

SUPERVISORS NAME: Stephanie Cifuentes
LICENSING EVALUATOR NAME: Felisa Shirley
LICENSING EVALUATOR SIGNATURE: DATE: 02/28/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/28/2024
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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