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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198603275
Report Date: 11/01/2024
Date Signed: 11/01/2024 02:53:35 PM

Document Has Been Signed on 11/01/2024 02:53 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
MONTEREY PARK ASC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754
FACILITY NAME:FLYNN HOME CARE INCFACILITY NUMBER:
198603275
ADMINISTRATOR/
DIRECTOR:		AUCIONE COELHO EVEFACILITY TYPE:
735
ADDRESS:7153 CULLY AVETELEPHONE:
(562) 395-8118
CITY:WHITTIERSTATE: CAZIP CODE:
90606
CAPACITY: 4CENSUS: 4DATE:
11/01/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:20 AM
MET WITH:Leslie Eve, Administrator
Aucione Coelho Eve, Licensee		TIME VISIT/
INSPECTION COMPLETED:
03:00 PM
NARRATIVE
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Licensing Program Analysts (LPA) Daniel Konishi conducted an unannounced Annual Required Visit on 11/01/2024. LPA were met by Staff #1 (S1) explained the purpose of the visit and assisted with the tour of the facility. LPA met with the Administrator Leslie Eve and Licensee Aucione Coelho Eve arrived shortly after and explained the purpose of the visit. The facility has a fire clearance approved for four (4) ambulatory clients. All clients receive services from East Los Angeles Regional Center. LPAs requested and obtained a copy of Personnel Report, and Resident Roster.

The following 12 (CARE) tool domains were observed and reviewed: Infection Control, Physical Plant/Environment Safety, Operational Requirements, Staffing, Personnel Records/Staff Training, Client Rights/Information, Client Records/Incident Reports, Food Service, Health Related Services, Incident Medical and Dental, Disaster Preparedness, and Emergency Intervention.

Infection Control:

Infection control practices, signs, and Personal Protective Equipment (PPEs) were observed.

LPA observed that the facility has an infection control plan in place.

Physical Plant/Environment Safety:

LPA conducted a tour of the facility with S1 and observed the following: The facility is a single-story building in a residential area, with a kitchen, dining room, 2 living rooms, 3 client bedrooms, 1 bathroom, backyard with shaded area and a garage. The front, back and side areas of the house are free of hazards.


Hallway closet: Contained plenty of linens, towels. Garage has sufficient PPEs and hygiene products in a locked cabinet. Fireplace is secured, closed, and inaccessible to clients. Showers also have non-skid materials. The hot water temperature measured at 112.8 degrees F between the required 105 - 120 degrees Fahrenheit in compliance with Tile 22 Regulations. The facility temperature at the time the visit was comfortable. Beds have the required furniture including bedframes, dressers, lamps, and chairs. Beds have the required linen and the linen is in good condition.
SUPERVISORS NAME: David Sicairos
LICENSING EVALUATOR NAME: Daniel Konishi
LICENSING EVALUATOR SIGNATURE: DATE: 11/01/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/01/2024
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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Document Has Been Signed on 11/01/2024 02:53 PM - It Cannot Be Edited


Created By: Daniel Konishi On 11/01/2024 at 02:19 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 CNTR DR. ST 500
MONTEREY PARK, CA 91754

FACILITY NAME: FLYNN HOME CARE INC
FACILITY NUMBER: 198603275

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/01/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
85064(k)
Administrator Qualifications and Duties
(k) Within six months of becoming an administrator, the individual shall receive training on HIV and TB required by Health and Safety Code Section 1562.5. Thereafter, the administrator shall receive updated training every two years.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, Administrator's file is missing training on HIV and TB which poses a potential health, safety or
personal rights risk to persons in care.
POC Due Date: 11/15/2024
Plan of Correction
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Administrator will send a copy of the HIV and TB training certificate to the LPA by the POC due date.
Type B
Section Cited
CCR
80068(a)
Admission Agreements
(a) The licensee shall complete an individual written admission agreement with each client and the client's authorized representative, if any.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, LPA reviewed Client #4 does not have the Admission Agreement in the clients' files which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 11/15/2024
Plan of Correction
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The Administrator will send a copy of Client#4 Admission Agreement by the POC due date.
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:David Sicairos
LICENSING EVALUATOR NAME:Daniel Konishi
LICENSING EVALUATOR SIGNATURE:
DATE: 11/01/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/01/2024


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
MONTEREY PARK ASC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754
FACILITY NAME: FLYNN HOME CARE INC
FACILITY NUMBER: 198603275
VISIT DATE: 11/01/2024
NARRATIVE
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Fire extinguishers were observed one (1) in the kitchen and one (1) in the living room near the front door entrance and both were last reviewed 02/23/2024. Smoke/carbon monoxide detectors are tested and in working condition. Cleaning supplies are kept locked underneath the kitchen sink and also locked in the cabinet in the garage away from food supplies. Sharps are kept locked in the kitchen drawer. Shared client bathroom was observed to be clean and contained soap and paper towels.

Operational Requirements:

The facility is licensed to serve four (4) ambulatory clients. Care and supervision to meet the clients’ needs was observed.



Staffing:

A total of six (6) full-time staff members provides care and supervision to the clients.



Personnel Records / Staff Training:

Administrator’s certificate effective on 08/28/2025. Administrator does not have required AIDS/HIV & TB training on file. Five (5) staff files were reviewed for criminal background clearance and training. Personnel records have health/Tuberculosis (TB) screenings, employee rights, certifications, CPI, and 1st Aid/CPR training. Facility has per regulation staff training in file.

Client Rights/Information:

Physician orders were reviewed in client files. Internet access is available for the clients use.



Client Records/Incident Reports:

Four (4) client files were reviewed containing admission agreements, Physician's Report, TB clearance, Individual Program Plan, personal rights, medication records, and Personal and Incidental (P & I) money were reviewed. Facility does not have Client #4 (C4) Admission Agreement on file.
SUPERVISORS NAME: David Sicairos
LICENSING EVALUATOR NAME: Daniel Konishi
LICENSING EVALUATOR SIGNATURE:

DATE: 11/01/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/01/2024
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
MONTEREY PARK ASC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754
FACILITY NAME: FLYNN HOME CARE INC
FACILITY NUMBER: 198603275
VISIT DATE: 11/01/2024
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Food Services:

Facility has sufficient supply of 2-day perishable & 7-day non-perishable food. LPA observed the Kitchen, food preparation area, and storage areas were observed to be clean and sanitary. Facility has no clients with restricted Health Care plans.

Health Related Services:

Clients are assisted with self-administration of prescription and non-prescription medications.
Three (3) centrally stored resident medication records were reviewed. First Aid Kit was reviewed and has required items. LPA observed cabinet located in the kitchen cabinet to be locked and inaccessible to residents. LPA reviewed three (3) out of four (4) client medications and Medication Administration Record (MAR).

Incidental Medical and Dental:

All clients have a Needs and Services Plan, and COVID-19 vaccination cards on file.

Disaster Preparedness, and Emergency Intervention:

A posted Emergency Disaster Plan LIC 610D containing emergency evacuation information was observed. An emergency drill was last documented on 10/18/2024.

Emergency Intervention:

No manual restraints or seclusion are used with clients in care.

Per California Code of Regulations, Title 22, and California Health and Safety Code, the deficiencies observed during the visit are documented on the LIC809D. Exit interview held and a copy of the report along with appeal rights were provided to the Licensee, Aucione Coelho Eve and Administrator, Leslie Eve.
SUPERVISORS NAME: David Sicairos
LICENSING EVALUATOR NAME: Daniel Konishi
LICENSING EVALUATOR SIGNATURE:

DATE: 11/01/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/01/2024
LIC809 (FAS) - (06/04)
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