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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198603027
Report Date: 01/21/2024
Date Signed: 01/21/2024 03:05:52 PM

Document Has Been Signed on 01/21/2024 03:05 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:CHARM HOUSE ARFFACILITY NUMBER:
198603027
ADMINISTRATOR:CHRISTAL CLARKFACILITY TYPE:
735
ADDRESS:351 E 121ST STTELEPHONE:
(323) 385-7349
CITY:LOS ANGELESSTATE: CAZIP CODE:
90061
CAPACITY: 3CENSUS: 2DATE:
01/21/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:22 PM
MET WITH:Christal ClarkTIME COMPLETED:
03:30 PM
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On 01/21/2024, Licensing Program Analyst (LPA) Antonine Richard conducted an unannounced Annual required visit with a primary focus on infection control measures. LPA was met by Christal Clarke, Administrator, and the purpose of today’s visit was explained. The facility is licensed to serve 3 developmentally disabled clients (age 18-59).


There are currently two (2) South Central Los Angeles Regional Center clients in placement. All two (2) clients are ambulatory. The facility is a single-story structure located in a residential neighborhood. It consists of the following: living & dining areas, kitchen, one (1) bathroom, two (2) client bedrooms, office, front and back yards.

LPA and administrator toured the physical plant. There are no bodies of water or firearm/ammunition on the premises. All client rooms were checked. Beds and bedding were in good condition, adequate lighting provided, storage for client personal belongings was observed. Walls and floors were in good repair. Bed linens, comforters, and bath towels were adequately stocked at the time of visit. Bathrooms were not found be within Title 22 regulations, yet were clean and operational. The water temperature measured at 119.1F Fin kitchen and 120. 1F in bathroom one (1). A comfortable temperature is maintained in the facility. LPA observed the facility to be clean and appropriately furnished at the time of visit. Storage areas for personal hygiene, cleaning agents, toxins, and sharps were inaccessible to clients. The kitchen was inspected and there is enough perishable and non-perishable food available which is stored properly. Fire extinguisher was charged, smoke detectors and Carbon Monoxide were operable.

See LIC809-C
SUPERVISORS NAME: Ulysses Coronel
LICENSING EVALUATOR NAME: Antonine Richard
LICENSING EVALUATOR SIGNATURE: DATE: 01/21/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/21/2024
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, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245
FACILITY NAME: CHARM HOUSE ARF
FACILITY NUMBER: 198603027
VISIT DATE: 01/21/2024
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During the visit, LPA observed the facility infection control practices. LPA observed screening protocols for visitors, staff and residents, sanitizing stations (Located in common areas and restrooms). LPA observed staff and residents were wearing face coverings, an isolation room and required postings throughout the facility were present. LPA observed the facility has a 30-day supply of Personal Protective Equipment (PPE) located in the office room.

LPA advised the Administrator to continuously monitor the Centers for Disease Control (CDC) website and Community Care Licensing Provider Informational Notices (PIN) for any updates relating to COVID-19 guidance.

During today’s visit there were no deficiencies observed.

Exit interview was held. A copy of the report was provided to the Administrator Christal Clarke.

SUPERVISORS NAME: Ulysses Coronel
LICENSING EVALUATOR NAME: Antonine Richard
LICENSING EVALUATOR SIGNATURE:

DATE: 01/21/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/21/2024
LIC809 (FAS) - (06/04)
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