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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198603320
Report Date: 03/24/2023
Date Signed: 03/24/2023 03:44:03 PM

Document Has Been Signed on 03/24/2023 03:44 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:
03/24/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
08:30 AM
MET WITH:Staff Kenneth CroomTIME COMPLETED:
12:00 PM
NARRATIVE
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Licensing Program Analysts (LPA) Jose Villalobos made an unannounced Annual inspection focused on domains within the Compliance and Regulatory Enforcement (Care) Tools. On today’s visit LPA met with staff Kenneth Croom and the purpose of the visit was discussed. Licensee Horis Hall arrived shortly after.

LPA toured the physical plant. Facility is a one story family home with three (3) bedrooms each for two (2) clients each vendorized through Eastern Los Angeles Regional Center. . 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 locked attached two (2) car garage.]

Physical Plant: Outdoor and indoor passageways are free of obstruction. Bathrooms were clean and operational with non-skid mats, water temperature in compliance. Smoke/carbon monoxide detectors were tested and operational. The last fire drill was conducted on 2/28/23. Fire extinguisher observed. Sufficient supply of extra linen, towels and personal hygiene supplies observed. Central Air and Heating with temperature comfortable. Washer/Dryer appliances observed and operational. Front and back yard is in good condition, shaded area is provided. FOOD: Food supply observed. Toxins and sharps locked and inaccessible to clients. BEDROOMS: Bedrooms #1-#3 had required furnishing. All client beds have the required linen/supplies which include, pillowcase, mattress padding, fitted sheet, blanket. MEDICATION: Medications are stored, locked and inaccessible to clients. RECORD REVIEW: Facility Administrator Certificate for Marsha Haywood is active. LPA reviewed (6) client records, (4) staff files, and (6) client medications. Emergency Disaster plan reviewed. POSTINGS: Required postings observed

Care Tool was completed and based on Title 22 Regulations, California Code of Regulations Title 22, Division 6, Chapter 8 is being cited on the attached LIC 809D.

An exit interview was conducted and a copy of today's report and appeal rights was provided and discussed.
SUPERVISORS NAME: Fernando Fierros
LICENSING EVALUATOR NAME: Jose Villalobos
LICENSING EVALUATOR SIGNATURE: DATE: 03/24/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/24/2023
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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Document Has Been Signed on 03/24/2023 03:44 PM - It Cannot Be Edited


Created By: Jose Villalobos On 03/24/2023 at 11:12 AM
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: TOP CHOICE HOMES
FACILITY NUMBER: 198603320

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/24/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
80075(f)
Health-Related Services
(f) Staff responsible for providing direct care and supervision shall receive training in first aid from persons qualified by agencies including but not limited to the American Red Cross.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on (record review)], the licensee did not comply with the section cited above in (3) of (4) staff files reviewed did not have the updated and active first aid/CPR certificates which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 03/31/2023
Plan of Correction
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Provide Licensing copies of the updated first aid training certifications, and if not able to locate, then faciltiy to schedule training for staff and provide Licensing with date of scheduled training.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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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:Fernando Fierros
LICENSING EVALUATOR NAME:Jose Villalobos
LICENSING EVALUATOR SIGNATURE:
DATE: 03/24/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/24/2023


LIC809 (FAS) - (06/04)
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