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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198603569
Report Date: 09/19/2023
Date Signed: 09/19/2023 03:12:08 PM

Document Has Been Signed on 09/19/2023 03:12 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:
09/19/2023
TYPE OF VISIT:Case Management - Annual ContinuationUNANNOUNCEDTIME BEGAN:
01:27 PM
MET WITH:Alisha Honore - AdministratorTIME COMPLETED:
03:30 PM
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Licensing Program Analyst (LPA) Tena Herrera conducted the required annual continuation inspection, focusing on one remaining domain and staff/client interviews. LPA arrived unannounced and met with Program Director Gbenga Sowunmi who assisted with the visit. The facility is 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.

During today’s visit LPA inspected the remaining one domain using the Compliance and Regulatory Enforcement (CARE) tools for which include the following:


Personnel Records-Training: Staff has criminal record clearance, current first aid and CPR, and ongoing training. Staff files are maintained at the facility and kept in the program directors office.

Initial visit on 9/15/23 included the following domains: (no deficiencies were observed during initial visit)
Infection Control: The facility staff are using appropriate hand hygiene and gloves while assisting clients’ medications. Staff are cleaning and disinfecting throughout the day. Facility has sufficient PPE supplies and has an Infection Control Plan.
Physical Plant & Environment Safety: LPA toured facility and observed 5 clients’ bedrooms, each room had the required furniture for comfort and safety and had sufficient lighting. No bodies of water were observed at the facility. There
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SUPERVISORS NAME: David Sicairos
LICENSING EVALUATOR NAME: Tena Herrera
LICENSING EVALUATOR SIGNATURE: DATE: 09/19/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/19/2023
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		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 RESIDENTIAL
FACILITY NUMBER: 198603569
VISIT DATE: 09/19/2023
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are no security bars or weapons on the premises. Hygiene products are readily available and stored in a storage room. The hot water temperature was tested throughout the facility shower rooms and measured within the required range of 105-120 degrees. All storage areas for cleaning solutions, toxins, knives, and hazardous items are stored in a secured/locked area and inaccessible to clients. The last Fire/Emergency Drill was conducted on 8/30/23. Smoke detectors and carbon monoxide detectors are operable and in compliance, there is an emergency sprinkler system throughout the facility. The fire extinguishers were observed and are fully charged.
Operational Requirements: The facility maintains accurate records of accounts, personal property and/or valuables. The facility provides care and supervision as necessary to meet the client’s needs.
Staffing: There facility appears to have two direct care staff on duty, on the premises any time the clients are in the facility and seem to have sufficient staffing at all times.
Client Rights-Information: Clients are provided with telephone and internet at the facility.
Client Records-Incident Reports: Client files are kept in a electronically secured and have the following documents in their files - Admission Agreements, Identification & Emergency Information, current Physician's Report, Pre-admission appraisal/Appraisal Needs & Services Plan.
Food Service: The kitchen was observed for the ability to prepare and serve food. Facility has a food waiver on file where facility receives daily deliveries of one hot meal and 2 cold meals. LPA observed emergency food supply and there was sufficient amount available to meet the needs of the clients in care.
Health Related Service: Staff designated to administer medication has the proper training on file. Medication is properly labeled and are centrally stored within the Medication Room and are in their original containers. During the visit, LPA reviewed 8 clients’ medication no issues were observed.
Incidental Medical & Dental: All medications for clients are kept locked and inaccessible to other clients.
Disaster Preparedness: The facility has an Emergency Disaster Plan with contact numbers and at least 2 relocation sites. Emergency Intervention: Clients at this facility do not have restraints nor do they require the use de-escalation techniques.
During today’s visit LPA conducted 6 staff interviews and 6 client interviews.
Per California Code of Regulations, Title 22, and California Health and Safety Code, there were no deficiencies observed during the visit.
Exit interview held and a copy of the report was provided to the Administrator Alisha Honore.
SUPERVISORS NAME: David Sicairos
LICENSING EVALUATOR NAME: Tena Herrera
LICENSING EVALUATOR SIGNATURE:

DATE: 09/19/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/19/2023
LIC809 (FAS) - (06/04)
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