198603188-12-22-2022-11-AS-PSCT-CMCNVG-20221222094755

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 198603188
Report Date: 12/22/2022
Date Signed: 12/22/2022 09:48:03 AM

Document Has Been Signed on 12/22/2022 09:48 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
EL SEGUNDO, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754

FACILITY NAME:	BRUCE & NELSON RESIDENTIAL FACILITY		FACILITY NUMBER:	198603188
ADMINISTRATOR:	NELSON, KENDRA D		FACILITY TYPE:	735
ADDRESS:	1722 WEST 165TH STREET		TELEPHONE:	(424) 785-5412
CITY:	COMPTON	STATE: CA	ZIP CODE:	90220
CAPACITY:	4	CENSUS: 3	DATE:	12/22/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	09:00 AM
MET WITH:	Kendra Nelson		TIME COMPLETED:	11:00 AM

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On 12/22/2022 at 9:00am, Licensing Program Analyst (LPA) Perry Scott conducted an unannounced annual required visit with a primary focus on infection control measures. LPA was met by Kendra Nelson, Director, and the purpose of today’s visit was explained. The facility is licensed to serve 4 developmentally disabled clients (Age 18-59), ambulatory only. The annual fees for the facility 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 currently three (3) SCLARC clients in placement. All (3) clients are ambulatory. The facility is a single-story structure located in a residential neighborhood. It consists of the following: 3 bedrooms, 3 bathrooms, family room/dining room, kitchen, living room, indoor and outdoor activity area, laundry room and an attached garage.

LPA Scott and Ms. Nelson 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. 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 was within title 22 guidelines. LPA observed that there was furniture in the back yard, Ms. Nelson said that she has planned to have it hauled away. LPA will follow up.

Report continues on LIC809-C

SUPERVISOR'S NAME: Janae Hammond	TELEPHONE: (323) 981-3328
LICENSING EVALUATOR NAME: Perry Scott	TELEPHONE: (323) 981-1755
LICENSING EVALUATOR SIGNATURE:	DATE: 12/13/2022

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/13/2022

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: BRUCE & NELSON RESIDENTIAL FACILITY	FACILITY NUMBER: 198603188
	VISIT DATE: 12/22/2022

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A comfortable temperature is maintained in the facility. LPA observed storage areas for cleaning agents, toxins, and sharps were inaccessible to clients. The kitchen was inspected and there is perishable and non-perishable food available which is stored properly. Fire extinguishers were charged, smoke/carbon monoxide detectors were operable.

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’s temperature was taken at the entrance, LPA was instructed to sign into a visitor logbook, and questions regarding COVID-19 were asked. LPA also observed that the required postings were 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.

During today’s visit there were no deficiencies observed.

An exit interview was conducted, and a copy of the Facility Evaluation Report was provided to Kendra Nelson.

SUPERVISOR'S NAME: Janae Hammond	TELEPHONE: (323) 981-3328
LICENSING EVALUATOR NAME: Perry Scott	TELEPHONE: (323) 981-1755
LICENSING EVALUATOR SIGNATURE:	DATE: 12/22/2022

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/22/2022

LIC809 (FAS) - (06/04)

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