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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198603211
Report Date: 10/28/2024
Date Signed: 10/28/2024 12:42:33 PM

Document Has Been Signed on 10/28/2024 12:42 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, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245
FACILITY NAME:NEW JOURNEY RESIDENTIAL LLCFACILITY NUMBER:
198603211
ADMINISTRATOR/
DIRECTOR:		COLE, KEITHFACILITY TYPE:
735
ADDRESS:1419 W. 59TH PLACETELEPHONE:
(310) 702-9572
CITY:LOS ANGELESSTATE: CAZIP CODE:
90047
CAPACITY: 4CENSUS: 2DATE:
10/28/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:02 AM
MET WITH:Keith ColeTIME VISIT/
INSPECTION COMPLETED:
12:42 PM
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On 10/28/2024, Licensing Program Analyst (LPA) Antonine Richard made unannounced Case Management visit to the facility above. LPA met with Administrator Keith Cole and explained the purposed of the visit was to to follow up on an SIR received on 10/25/24 about a client #1 (C1). C1 stabbed self with a knife and was transported to California Hospital.

LPA and the Administrator toured the facility to check for Health and safety. The administrator stated C1 was still at the hospital for a 51/50 and would be released today. LPA interviewed the staff #2 (S2) indicated that on 10/25/24 at 11:00 am, C1 walked from the kitchen to the living room after coming from the outside and stated C1 cut himself. S2 noticed blood coming out of the shirt. S2 immediately called 911. At 11:15 am, the Los Angeles Police Department (LAPD) and Paramedics arrived at the facility and transported C1 to the hospital. LPA could not interview C1 because C1 was still in the hospital. During this visit, LPA obtained the client's (C1) documents.

No deficiencies were cited.
An exit interview was conducted and a copy of this report was provided.
SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Antonine Richard
LICENSING EVALUATOR SIGNATURE: DATE: 10/28/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/28/2024
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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