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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198603158
Report Date: 12/10/2022
Date Signed: 12/10/2022 12:16:42 PM

Document Has Been Signed on 12/10/2022 12:16 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: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: 3DATE:
12/10/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:43 AM
MET WITH:Brian SullivanTIME COMPLETED:
01:00 PM
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On 12/10/2022 at 11:43am, Licensing Program Analyst (LPA) Perry Scott conducted an unannounced annual inspection visit with a primary focus on infection control measures using the new cares tool. LPA was met by Brian Sullivan and the purpose of today’s visit was explained. The facility is licensed to serve three (3) ambulatory clients ages (18-59). 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. 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 three (3) one Regional Center consumer in placement. 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 Scott and Brian Sullivan toured the entire facility inside and out. Documents are posted as mandated by the DPH and CCLD. All client rooms were checked. Beds and bedding were in good condition, adequate lighting provided, storage for client personal belongings was observed. The bathrooms are clean and operational. Smoke/carbon monoxide detectors are operable. No firearms are stored at facility and no bodies of water present.

Continued on LIC809-C

SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Perry Scott
LICENSING EVALUATOR SIGNATURE: DATE: 12/10/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/10/2022
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: ONE CARE ADULT RESIDENTIAL HOME
FACILITY NUMBER: 198603158
VISIT DATE: 12/10/2022
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Medications are stored, locked and inaccessible to clients. The water temperature is at 118.5 degrees f. A comfortable temperature is maintained in the facility. LPA observed an ample supply of perishable and nonperishable food. Bed linens and personal hygiene supplies are adequate, hazardous toxins and/or items are inaccessible to clients. Fire extinguishers are fully charged. LPA observed a First Aid kit complete with manual. Exit, walkways and/or passageways, front and back yard are free of debris and/or hazards. The facility is in good repair. LPA reviewed two client files and two staff files. The last fire drill was on 10/07/22.

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 and the facility had the required postings posted throughout the facility.



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

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 the Facility Evaluation Report was provided.

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

DATE: 12/10/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/10/2022
LIC809 (FAS) - (06/04)
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