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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198603320
Report Date: 03/24/2022
Date Signed: 03/24/2022 04:56:47 PM

Document Has Been Signed on 03/24/2022 04:56 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
CCLD Regional Office, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754
FACILITY NAME:TOP CHOICE HOMESFACILITY NUMBER:
198603320
ADMINISTRATOR:HAYWOOD, MARSHAFACILITY TYPE:
735
ADDRESS:9134 ARMLEY AVE.TELEPHONE:
(626) 445-7100
CITY:WHITTIERSTATE: CAZIP CODE:
90603
CAPACITY: 6CENSUS: 6DATE:
03/24/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:05 PM
MET WITH:Administrator Marsha HaywoodTIME COMPLETED:
03:45 PM
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Licensing Program Analysts (LPA) Jose Villalobos and Ashley Calderon made an unannounced Annual inspection focused on Infection Control. On today’s visit LPA met with staff Kailan Hall and the purpose of the visit was discussed. Administrator Marsha Haywood arrived shortly after.

As a part of the inspection, LPA used the inspection tool, reviewed (6) client records, (3) staff files, and (6) client medications. Currently the facility has (6) clients which are ambulatory. The facility is vendorized through Eastern Los Angeles Regional Center. Facility is a one story family home with three (3) bedrooms each for (2) clients. There are (2) bathrooms of which (1) is for client use. There is also a living room, a den, a kitchen, central air and heating, a dining area, staff office, a laundry room, a shaded area located in the backyard. A attached two (2) car garage inaccessible to clients. Front and back yard is in good condition at time of visit. Washer/Dryer appliances observed. Toxins and sharps locked and inaccessible to clients. Bedrooms #1-#3 are equipped with a (2) beds each, a dresser, lamp, chair, overhead lightning for each client. Bathroom #1-#2 has a working toilet, wash basin, and shower. Beds have the required linen/supplies which include, pillowcase, mattress padding, fitted sheet, blanket and bedspreads. Supply of hygiene supplies were observed. Fire alarms are interconnected and operational. Required postings observed. Water temperature within required tittle 22 regulations.

Infection control domain completed and there were no deficiencies. An exit interview was conducted and a copy of this report was provided to Administrator Marsha Haywood
SUPERVISORS NAME: Fernando Fierros
LICENSING EVALUATOR NAME: Jose Villalobos
LICENSING EVALUATOR SIGNATURE: DATE: 03/24/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/24/2022
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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