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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198603569
Report Date: 09/08/2022
Date Signed: 09/08/2022 10:56:55 AM

Document Has Been Signed on 09/08/2022 10:56 AM - 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:CENTRAL STAR RANCHO LOS AMIGOS CRISIS RESIDENTIALFACILITY NUMBER:
198603569
ADMINISTRATOR:HONORE HARRELL, ALISHAFACILITY TYPE:
772
ADDRESS:7745 LEEDS STREETTELEPHONE:
(310) 283-6694
CITY:DOWNEYSTATE: CAZIP CODE:
90242
CAPACITY: 16CENSUS: 0DATE:
09/08/2022
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Alisha Honore HarrellTIME COMPLETED:
11:15 AM
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Licensing Program Analyst (LPA) Glenn Trueman made an announced visit and was greeted by Administrator Alisha Honore Harrell, Program Director Steve Albrecht, Aldric Logan L.A. County Department of Mental Health (DMH) and Nicholas Ruguone Facilities and Warehouse and explained the reason for the visit.
The purpose of the visit is to conduct the pre licensing visit.
LPA along with the group toured the facility today 09/08/2022 at 9:45 AM and the following was observed:
Facility contains a 1st and 2nd Floor. The 1st floor has 2 Client Bedrooms, 3 Client Restrooms and 2 Client Showers. The 2nd Floor contains 6 Client Restrooms, 3 Client Restrooms and 3 Client Showers.
Within the 2 floors are 2 laundry rooms, Assessment Program, Linen storage, 3 television rooms, kitchen. medication room, nursing station and staff rooms.
Locked storage area for central storage of medications is available.
Walls, ceilings, floors, carpeting, window screens, and areas around the facility are clean, painted and/or in good repair.
Locked storage area for poisons, toxic, cleaning solutions, and disinfectants. Doors, stairways, and passageways are unobstructed. An emergency exiting plan and emergency phone numbers posted in an appropriate place. An operating telephone on the premises and available to clients.
First aid supplies, which include sterile first aid dressings, bandages, adhesive tapes, scissors, tweezers, thermometer, antiseptic solution, and a current first aid manual is maintained. Appliances such as microwaves, refrigerators, stoves, etc. are clean and operating properly. Furniture is room/client appropriate, clean and in good repair. Each client has an adult bed with mattress, pad, bedsprings, and pillow, which are clean and in good repair. Each client has an adequate dresser and closet space for clothing and other belongings that includes at least 2 drawers or 8 cubic feet of dresser space. A sufficient supply of linens to permit weekly changing or more often to insure clean linen at all times for clients. Equipment and supplies for client personal hygiene is available and on site.
Physical Plant met Title 22 requirements. Component 3 conducted at today's visit.
Exit interview conducted.
SUPERVISORS NAME: Wei Siew Ho
LICENSING EVALUATOR NAME: Glenn Trueman
LICENSING EVALUATOR SIGNATURE: DATE: 09/08/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/08/2022
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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