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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198603569
Report Date: 09/15/2023
Date Signed: 09/15/2023 04:51:51 PM

Document Has Been Signed on 09/15/2023 04:51 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
GREATER LA AC/SC, 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:
(562) 719-2866
CITY:DOWNEYSTATE: CAZIP CODE:
90242
CAPACITY: 16CENSUS: 14DATE:
09/15/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:30 PM
MET WITH:Alisha Honore - AdministratorTIME COMPLETED:
05:00 PM
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Licensing Program Analyst (LPA) Tena Herrera conducted an unannounced visit for an Annual Inspection. Upon arrival, LPA met with Alisha Honore (Administrator) explained the purpose for the visit. The facility is a shot term residential program licensed to serve 16 Ambulatory clients.

This is a 2-story facility located in an industrial area in Downey, Ca. A tour of the facility includes: First Floor: 2 client bedrooms, janitor closet, staff restroom, living room, nurse station, 2 restrooms, 1 shower room, medication room, multi-purpose room, dining room, kitchen, assessment room, storage room (with emergency food supply), program director office, laundry room, control panel room, and an intake room with restroom/shower. Second floor: 6 client bedrooms, administrators office, 3 shower rooms, 3 restrooms, laundry room, clinician station, staff restroom, and janitor closet.

Due to time constraints, LPA will continue this inspection at a later date. LPA was unable to review staff records or conduct client/staff interviews during todays visit. LPA will return to continue the required 1-year annual inspection.

SUPERVISORS NAME: David Sicairos
LICENSING EVALUATOR NAME: Tena Herrera
LICENSING EVALUATOR SIGNATURE: DATE: 09/15/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/15/2023
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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