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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198603232
Report Date: 10/23/2024
Date Signed: 10/23/2024 02:27:32 PM

Document Has Been Signed on 10/23/2024 02:27 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:AMAZING EFFORTS VIII, LLCFACILITY NUMBER:
198603232
ADMINISTRATOR/
DIRECTOR:
HENSON, TAMARAFACILITY TYPE:
735
ADDRESS:414 N. PEARL AVETELEPHONE:
(323) 236-8523
CITY:COMPTONSTATE: CAZIP CODE:
90221
CAPACITY: 4CENSUS: 4DATE:
10/23/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:38 PM
MET WITH:Administrator Ivette GomezTIME VISIT/
INSPECTION COMPLETED:
02:35 PM
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On 10/23/24, Licensing Program Analyst (LPA) Villegas conducted an unannounced annual required visit using the CARE Inspection Tool. LPA met with Administrator Ivette Gomez as the purpose of the visit was explained. The facility is licensed to serve 4 ambulatory clients (age 18-59) of which two (2) may be non-ambulatory. Clients are linked to the South Central Regional Center. Administrator was provided with the upcoming annual fees and pin info.

The facility consists of the following; 4 bedrooms, 2 bathrooms, living room, dining area, kitchen, laundry area, linen closet, a backyard with a covered patio for shade, outdoor activities area, an outdoor staff office and a small visitation room that houses a deep freezer, serves as storage, and has a half restroom. Perishable and non-perishable food supply was checked and adequately stocked at time of visit. 1 fire extinguisher fully charged and mounted in kitchen area, toxins and knifes were observed to be stored and inaccessible to clients. There are no bodies of water nor firearms on the property, exits and walkways are free of debris/hazards.

LPA conducted a records review of 2 staff records, 4 client record, 4 medication administration record, and 3 P&I records, no discrepancies observed. Medications were centrally stored and properly locked, first aid kit was checked and fully stocked. The last fire was conducted on 10/04/24, carbon monoxide and smoke detectors observed to be operational. Landline and internet service were observed.

Client bedrooms were checked, mattresses and box springs were in good condition, adequate lighting, plenty of dresser and closet space was observed. Bathroom toilets and water faucets worked properly, shower was free of mold/mildew, and there are sufficient toiletries accessible to clients. The water temperature properly measured between 105-120 F..

Exit interview conducted with Administrator Ivette Gomez, and a copy of this report was provided.

SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Lizeth Villegas
LICENSING EVALUATOR SIGNATURE: DATE: 10/23/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/23/2024
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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