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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198603336
Report Date: 05/16/2024
Date Signed: 05/16/2024 01:23:52 PM

Document Has Been Signed on 05/16/2024 01:23 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, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754
FACILITY NAME:BAILEY'S PLACE ADULT COMMUNITY CENTER LLCFACILITY NUMBER:
198603336
ADMINISTRATOR/
DIRECTOR:		BROOKS, BRANDIFACILITY TYPE:
775
ADDRESS:1216-1218 E. ROSECRANS AVETELEPHONE:
(214) 240-4247
CITY:COMPTONSTATE: CAZIP CODE:
90221
CAPACITY: 32CENSUS: 26DATE:
05/16/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:10 AM
MET WITH:Facility Manager - Yolanda Green-WillimasTIME VISIT/
INSPECTION COMPLETED:
01:30 PM
NARRATIVE
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On 05/16/2024 at around 8:00 AM, Licensing Program Analyst (LPA) Leandro conducted an unannounced Required – 1 Year Inspection to the above-named facility and met with the Facility Manager Yolanda Green-Willimas. LPA explained the purpose of the visit and was accompanied by a staff member inside and outside the facility during this inspection.

This facility is licensed to serve 32 ambulatory adults ages 18 – 59 years.
A total of 26 ambulatory clients are currently enrolled in this facility.
The facility has a balance of $303 of Annual Licensing Fees due on 5/28/2024.

The facility is a one-story building located on a main street. The facility consists of 1 receptionist room, 1 activity room, 1 conference room, kitchen area, 2 offices, 2 bathrooms, and a backyard patio area with shaded seating.

Outside grounds were toured and no bodies of water were observed. The patio furniture is under a shaded area and accessible to clients. Walkways around the facility were clear of hazards. There are no security bars or weapons on the premises.
SUPERVISORS NAME: Ulysses Coronel
LICENSING EVALUATOR NAME: Socorro Leandro
LICENSING EVALUATOR SIGNATURE: DATE: 05/16/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/16/2024
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 05/16/2024 01:23 PM - It Cannot Be Edited


Created By: Socorro Leandro On 05/16/2024 at 01:05 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 DR #100
MONTEREY PARK, CA 91754

FACILITY NAME: BAILEY'S PLACE ADULT COMMUNITY CENTER LLC
FACILITY NUMBER: 198603336

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/16/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
82069(b)(1)
Client Medical Assessments
(b) The medical assessment shall include the following: (1) The results of an examination for communicable tuberculosis and other contagious/infectious diseases.

This requirement is not met as evidenced by:
Deficient Practice Statement
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4
Based on record review, the licensee did not comply with the section cited above in not having 2 out of 5 client tuberculosis test results which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 05/31/2024
Plan of Correction
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Licensee will email tuberculosis test results for Client 1 and Client 5 to Socorro.Leandro@dss.ca.gov.
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:Ulysses Coronel
LICENSING EVALUATOR NAME:Socorro Leandro
LICENSING EVALUATOR SIGNATURE:
DATE: 05/16/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/16/2024


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
EL SEGUNDO ASC, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754
FACILITY NAME: BAILEY'S PLACE ADULT COMMUNITY CENTER LLC
FACILITY NUMBER: 198603336
VISIT DATE: 05/16/2024
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Documents are posted as mandated. First aid kit is fully stocked with manual. Smoke and carbon monoxide detectors were in compliance and operational. There are several fire extinguishers around the facility, and they were last serviced on 6/7/2023. LPA tested hot water temperature and it measured between 105 and 120 degrees Fahrenheit.

5 staff records were reviewed, 5 out of 5 staff records had required documentation.
5 client records were reviewed and, 5 out of 5 client records had Admission Agreements.

Deficiencies are being cited based on LPA record review in accordance with the California Code of Regulations, Title 22, see LIC809D. A violation regarding tuberculosis test results.

An exit interview was conducted, Plans of Corrections were reviewed and developed. A copy of this report and appeal rights were discussed and left with the Facility Manager.
SUPERVISORS NAME: Ulysses Coronel
LICENSING EVALUATOR NAME: Socorro Leandro
LICENSING EVALUATOR SIGNATURE:

DATE: 05/16/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/16/2024
LIC809 (FAS) - (06/04)
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