<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198603158
Report Date: 09/27/2021
Date Signed: 09/28/2021 11:46:00 AM

Document Has Been Signed on 09/28/2021 11:46 AM - 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:ONE CARE ADULT RESIDENTIAL HOMEFACILITY NUMBER:
198603158
ADMINISTRATOR:SULLIVAN, BRIANFACILITY TYPE:
735
ADDRESS:1330 W MAGNOLIA STTELEPHONE:
(310) 926-3109
CITY:COMPTONSTATE: CAZIP CODE:
90220
CAPACITY: 4CENSUS: 1DATE:
09/27/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Brian Sullivan, LicenseeTIME COMPLETED:
01:00 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
Licensing Program Analyst (LPA) Ana Soto conducted an unannounced Annual inspection visit and infection control inspection to the above facility. LPA was met by Kaliyah hardy, and later met with Brian Sullivan, Licensee and the purpose of today’s visit was explained.

There are currently (1) one Regional Center consumer in placement. (1) client is ambulatory. The facility is a single-story structure located in a residential neighborhood. It consists of the following: 3 bedrooms, 2 bathrooms, living room/office, dining room & kitchen, shaded area, indoor and outdoor activity area, laundry room and attached garage.

LPA, Kaliyah, and Brian toured the entire facility inside and out. Documents are posted as mandated by the DPH and CCLD. Bedrooms 1 is occupied by client and contain the mandated furniture. Bedroom 2 & 3 are not occupied. The (2) bathrooms are clean and operational. Smoke detectors and carbon monoxide detector are in compliance and operational. No firearms are stored at facility and no bodies of water present. Medications are stored, locked and inaccessible to clients. 1 staff file is current, 1 resident file is current takes no medications. The water temperature is at 113 degrees. A comfortable temperature is maintained in the facility. Ample supply of perishable and nonperishable food, linens and personal hygiene supplies are adequate, hazardous toxins and/or items are inaccessible to clients, 1 fire extinguishers are fully charged. 1 First Aid kit complete and with manual. Exit, walkways and/or passageways, front and back yard are free of debris and/or hazards. The facility is in good repair. During the visit, LPA observed the facility infection control practices. LPA observed a sanitizing station at the facility entry, and additional sanitation supplies in the laundry room and coverts. LPA observed staff and clients wearing masks, 2 private rooms will be converted to isolation rooms (if needed) 3rd bedroom is a shared bedroom, they will move client to another bedroom (if needed) to make 3rd an isolation room and required postings throughout the facility. LPA observed that a sanitizer is in the client's room. The facility has an approved Mitigation plan. Visitors are logged and checked. The client’s temperature is checked and logged 3x a day. Staff and client are vaccinated.

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 conducted with Brian Sullivan, Licensee and copy of report provided.

SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Ana Soto
LICENSING EVALUATOR SIGNATURE: DATE: 09/27/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/27/2021
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 1