198603211-10-25-2023-11-AS-ARID-CWXTJ2-20231025144538

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 198603211
Report Date: 10/25/2023
Date Signed: 10/25/2023 02:45:57 PM

Document Has Been Signed on 10/25/2023 02:45 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 ASC, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754

FACILITY NAME:	NEW JOURNEY RESIDENTIAL LLC		FACILITY NUMBER:	198603211
ADMINISTRATOR:	COLE, KEITH		FACILITY TYPE:	735
ADDRESS:	1419 W. 59TH PLACE		TELEPHONE:	(310) 702-9572
CITY:	LOS ANGELES	STATE: CA	ZIP CODE:	90047
CAPACITY: 4		CENSUS: 4	DATE:	10/25/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	10:39 AM
MET WITH:	COLE KEITH		TIME COMPLETED:	02:45 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	On 10/25/2023, Licensing Program Analyst (LPA) Antonine Richard conducted an unannounced required 1- year visit using the new CARE Inspection Tool. LPA Richard met with Administrator Keith Cole. LPA Richard explained the purpose of today's visit. LPA verified that the facility has an approved mitigation plan report. There are currently four (4), South Central Los Angeles Regional Center (SCLARC) consumers in placement. The facility's annual fees are current. The following Domain will be observed and reviewed: Infection Control Practices "I will be using this tool and methods that have been developed to improve the efficiency and accuracy of the Department of Social Services facility inspections." The facility is a two (2) story single-family home located in a residential neighborhood. LPA Richard and Administrator Cole toured the facility which consisted of the following: Living room, dining area, kitchen, 4 bedrooms, 3 bathrooms, laundry room, backyard shaded area, indoor/outdoor activity areas, and a detached garage. The front and back yard landscape is in good condition at the time of the visit. See continued LIC809-C on page 2

SUPERVISORS NAME: Ulysses Coronel
LICENSING EVALUATOR NAME: Antonine Richard
LICENSING EVALUATOR SIGNATURE:	DATE: 10/25/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/25/2023

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 ASC, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754

FACILITY NAME: NEW JOURNEY RESIDENTIAL LLC	FACILITY NUMBER: 198603211
	VISIT DATE: 10/25/2023

NARRATIVE

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Continued LIC809-C page 2

LPA-observed documents are posted as mandated. Bedrooms contain the required furniture, Bathrooms are clean and operational. Personal accommodations were observed for safety, privacy, comfort. The kitchen was observed for its ability to prepare and serve food. The food service was reviewed for appropriate quantity and proper storage; there was an ample supply of perishable and nonperishable food.

The resident’s medications were reviewed for proper storage, documentation, and system implementation. Medications records are current. Common areas were observed for the ability to safely serve the needs of the residents, including cleanliness, and clearness of any potential hazards to the residents. The first aid kit is fully stocked with manual, smoke, and carbon monoxide detectors were in compliance. The hot water temperature was measured at 138. 8F to 135. 7F degrees Fahrenheit. The fire extinguishers are fully charged, adequate linen supply, the facility has a telephone line. The resident's bedroom windows have no sliding window lock with thumbscrews, all exit doors were in compliance, the yard was free of debris hazards, and trash cans were covered. Staff was given training on dependent adult and elder abuse reporting. The facility conducted a fire drill on 08/03/2023. The Liability Insurance is current.

Deficiencies and Technical Violations were issued under California Code of Regulations, Title 22, Division 6, Chapter 8.

An exit interview was conducted and a plan of corrections was developed.

A copy of the facility evaluation report and appeal rights was provided to Administrator Keith Cole.

SUPERVISORS NAME: Ulysses Coronel
LICENSING EVALUATOR NAME: Antonine Richard
LICENSING EVALUATOR SIGNATURE:	DATE: 10/25/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/25/2023

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 10/25/2023 02:45 PM - It Cannot Be Edited

Created By: Antonine Richard On 10/25/2023 at 02:21 PM

Link to Parent Document Below:

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754

FACILITY NAME: NEW JOURNEY RESIDENTIAL LLC	FACILITY NUMBER: 198603211
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 10/25/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type A

Section Cited

CCR

80088(e)(1)

Fixtures, Furniture, Equipment, and Supplies

(e) Faucets used by clients for personal care such as shaving and grooming shall deliver hot water. (1) Hot water temperature controls shall be maintained to automatically regulate temperature of hot water delivered to plumbing fixtures used by clients to attain a hot water temperature of not less than 105 degrees F (40.5 degrees C) and not more than 120 degrees F (48.8 degrees C). This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation, and interview the licensee did not comply with the section cited above the hot water temperature tested at 138. 8F to 135. 7F degrees which poses an immediate health, safety or personal rights risk to persons in care.
	POC Due Date: 10/26/2023
	Plan of Correction
1 2 3 4	The Licensee will adhere to Title 22 Section 80088(e)(1). Licensee will submitted to LPA via email Antonine.Richard@dss.ca.gov the plan of correction by due date. 10/26/2023

Section Cited


	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

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:

Ulysses Coronel

LICENSING EVALUATOR NAME:

Antonine Richard

LICENSING EVALUATOR SIGNATURE:

DATE: 10/25/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/25/2023

LIC809 (FAS) - (06/04)

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