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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198603034
Report Date: 03/25/2022
Date Signed: 03/25/2022 06:14:22 PM


Document Has Been Signed on 03/25/2022 06:14 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
MONTEREY PARK, CA 91754



FACILITY NAME:WRIGHT PLACE BOARD AND CARE IIFACILITY NUMBER:
198603034
ADMINISTRATOR:BYERS, MAZERATTIFACILITY TYPE:
735
ADDRESS:4146 ARLINGTON AVENUETELEPHONE:
(323) 595-7917
CITY:LOS ANGELESSTATE: CAZIP CODE:
90008
CAPACITY:4CENSUS: 4DATE:
03/25/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:45 AM
MET WITH:Maalik ByersTIME COMPLETED:
12:20 PM
NARRATIVE
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On 3/25/2022 Licensing Program Analysts (LPA) Ngozi Nwaokoro conducted an unannounced Required -1 year visit, with emphasis on infection control and met with the Director, Maalik Byers. The purpose of the visit was explained to him. The facility is licensed to serve four (4) ambulatory adults ages 18 to 59, with developmental disability.

The facility physical plant is a single-story structure that consists of a living room, 4 client bedrooms, 2 bathrooms, kitchen and dining room.

LPA Nwaokoro and the director toured the entire facility which included: Living room, office area, kitchen, dining room, 4 resident bedrooms and 2 bathrooms front yard, back yard and a detached garage. Bedrooms contained the required linen and furniture’s. Bathrooms are clean and operational, smoke detectors/carbon monoxide detectors are working and operational. Fire extinguishers are fully charged and located on the wall in the kitchen area, and dining room area. The first aid kit with manual was observed to be in compliance. Hot water was checked, and water temperature measured at 119.F.

LPA observed the nonperishable and perishable supply of food to be in compliance. Medication and MAR logs are stored in a locked cabinet in the kitchen area. The back yard and outside area was observed. LPA also reviewed staff files and residents’ files.

During today’s visit a deficiency was observed Title 22 Regulations are being cited, please see LIC9099D.

Exit interview held. A copy of the report and appeal rights was provided to Maalik Byers, Director.
SUPERVISOR'S NAME: Michael CavaTELEPHONE: (323) 400-7397
LICENSING EVALUATOR NAME: Ngozi NwaokoroTELEPHONE: (323) 981-1755
LICENSING EVALUATOR SIGNATURE:
DATE: 03/25/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/25/2022
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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Document Has Been Signed on 03/25/2022 06:14 PM - It Cannot Be Edited

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
MONTEREY PARK, CA 91754


FACILITY NAME: WRIGHT PLACE BOARD AND CARE II
FACILITY NUMBER: 198603034

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/25/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
80086(a)

Prio to construction or alterations, all licensees shall notify the licensing agency of the proposed change.
This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, interview, record review, the licensee did not comply with the section cited above in the facility which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 04/08/2022
Plan of Correction
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Administrator has to notify the city and get approval, fire masheral to inspect and approve. Send the approval to DSS. In the time been, no one has the live in the garage.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Michael CavaTELEPHONE: (323) 400-7397
LICENSING EVALUATOR NAME: Ngozi NwaokoroTELEPHONE: (323) 981-1755
LICENSING EVALUATOR SIGNATURE:
DATE: 03/25/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/25/2022
LIC809 (FAS) - (06/04)
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