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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198603099
Report Date: 12/01/2022
Date Signed: 12/01/2022 02:20:27 PM

Document Has Been Signed on 12/01/2022 02:20 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:AMAZING EFFORTS VI LLCFACILITY NUMBER:
198603099
ADMINISTRATOR:HENSON, TAMARAFACILITY TYPE:
735
ADDRESS:548 W BENNETT STTELEPHONE:
(310) 933-8486
CITY:COMPTONSTATE: CAZIP CODE:
90220
CAPACITY: 4CENSUS: 4DATE:
12/01/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:28 PM
MET WITH:Vanessa Kasse, Ivette GomezlTIME COMPLETED:
03:00 PM
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On 12/01/2022 at 1:32pm, Licensing Program Analyst (LPA) Perry Scott conducted an unannounced annual inspection visit with a primary focus on infection control measures. LPA was met by Vanessa Kassel, staff and Ivette Gomez, administrator; and the purpose of today’s visit was explained. The facilities annual fees are current.

As part of the inspection, my primary focus was on infection control. LPA observed the facility’s infection control practices: LPA observed a sanitizing station at the facility entrance. LPA’s temperature was taken upon entry. PPE supplies are readily available to staff and residents, and additional supplies are stored. Sufficient paper, cleaning, and disinfecting supplies were observed. The facility has the mandated COVID infection control posters.


There are currently (4) four Regional Center consumers in placement. All (4) clients are ambulatory. The facility is a single-story structure located in a residential neighborhood. It consists of the following: 4 bedrooms, 4 bathrooms, family room/office, lounge, living room, kitchen, dining room, shaded area, laundry room area, indoor and outdoor activity area, music room, vegetable garden, horse stables converted into storage areas, and a detached garage (game room).

Report continues on LIC809-C

SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Perry Scott
LICENSING EVALUATOR SIGNATURE: DATE: 12/01/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/01/2022
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
EL SEGUNDO, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754
FACILITY NAME: AMAZING EFFORTS VI LLC
FACILITY NUMBER: 198603099
VISIT DATE: 12/01/2022
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LPA Scott and Ms. Kassel toured the entire facility inside and out. Documents are posted as mandated by the DPH and CCLD. 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 found to be within Title 22 regulations and were clean and operational. The water temperature measured 115.8 degrees F.

During the visit, LPA observed the facility infection control practices. LPA observed a sanitizing station at the facility entrance, sanitizer/soap in the bathrooms and additional sanitation supplies in a locked cabinet located in the garage. LPA observed staff and clients wearing masks. The facility has an approved Mitigation plan. Visitors are checked in at the entrance where their temperature is taken and logged into the sign in sheet.

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

LPA did not observe any deficiencies on this visit. No citations were issued.

An exit interview was conducted with Vanessa Kassel, staff and Ivette Gomez, Administrator.

A copy of the facility evaluation report was given.

End of report.

SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Perry Scott
LICENSING EVALUATOR SIGNATURE:

DATE: 12/01/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/01/2022
LIC809 (FAS) - (06/04)
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