198603570-4-14-2025-28-AS-NGAA-DFQM5W-20250414091902

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 198603570
Report Date: 03/24/2025
Date Signed: 04/14/2025 09:20:00 AM

Document Has Been Signed on 04/14/2025 09:20 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:	PEOPLE'S CARE MCGEE		FACILITY NUMBER:	198603570
ADMINISTRATOR/ DIRECTOR:	THOMAS, JASMINE		FACILITY TYPE:	737
ADDRESS:	12545 MCGEE DRIVE		TELEPHONE:	(909) 287-3557
CITY:	WHITTIER	STATE: CA	ZIP CODE:	90606
CAPACITY: 4		CENSUS: 1	DATE:	03/24/2025
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	09:15 AM
MET WITH:	Jasmine Thomas, Administrator		TIME VISIT/ INSPECTION COMPLETED:	01:05 PM

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Licensing Program Analyst (LPA) Galarza conducted an unannounced Required- 1 year visit. The purpose of the visit was explained to RBT House Lead Keandra Okeke. Administrator Jasmine Thomas arrived later. The facility is as an Enhanced Behavioral Support Home (EBSH) for developmentally disabled adults ages 18-59 years old vendored by Eastern Los Angeles Regional Center.

The following were observed/inspected:

Infection Control: The Infection Control Plan includes Environmental cleaning and disinfection activities. Facility has sufficient Personal Protective Equipment.

Physical Plant/Environment Safety: The EBSH home is a single-story home consisting of four (4) bedrooms, two (2) full non-ambulatory bathrooms, kitchen, dining room, TV area, family room, laundry room, office, a detached activity room. The backyard has a covered patio area with patio furniture and a basketball court. Water temperature readings measured within the required 105 - 120 degrees Fahrenheit. The facility has a 1st Aid Kit and Manual. Cleaning supplies, knives, and toxic substances were locked and inaccessible to residents.

The facility has an approved fire clearance for secured perimeter with delayed egress that is operational. The home is equipped with automatic sprinkler system and fire door. Exit doors are free of any obstruction and there are no pools or large bodies of water. Smoke and carbon monoxide detectors were tested and are operational. There are two (2) fire extinguishers in the facility.

*The north west fire door does not close automatically. A citation was issued.

Operational Requirements: Fire clearance is approved for four (4) non-ambulatory residents. The last fire inspection was conducted on 3/18/25 by CA State Fire Protection. Special equipment and supplies are not used by the resident. The Surety Bond is current. Care and supervision to meet the clients needs was observed. Resident (R1) requires 2 to 1 staff ratio in the home and 3 to 1 staff in community outings.

NAME OF LICENSING PROGRAM MANAGER: Lisa Hicks
NAME OF LICENSING PROGRAM ANALYST: Noemi Galarza
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 03/24/2025

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/24/2025

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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California Health & Human Services Agency

California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:

Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.

Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)

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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
CCLD Regional Office, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754

FACILITY NAME: PEOPLE'S CARE MCGEE	FACILITY NUMBER: 198603570
	VISIT DATE: 03/24/2025

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Staffing: A total of 26 staff members provide care and supervision to the clients. 13 out of 26 staff are Registered Behavior Technicians (RBT's). RBT certifications are current.

Personnel Records/Staff Training: Administrator certificate expires 8/15/26. Staff have criminal background clearance and training. Seven (7) staff files were reviewed. Proof of staff training, health and TB clearance, RBT and/or DSP, 1st Aid/CPR training are on file. Consultant logs, RBT Log, and CEUs & Certifications were reviewed.

Client Rights/Information: Physician orders, and personal rights were reviewed in client files.

Client Records/Incident Reports: One (1) resident file was reviewed. Admission agreements, Physician's Report, medical/functional assessments, Indi, TB clearance, IPP reports, personal rights, medical consent, dietician report, consultant logs, Personal & Incidental (P & I) monies/records, and Medication Administration Records were reviewed. HCBS Tenant/Landlord Agreements are in files. P & I money records were reviewed.

Food Service: The kitchen was inspected and has sufficient supply of 2 day perishable & 7 day non-perishable food. Kitchen, food preparation area, and storage areas were observed to be clean and sanitary. No residents have a modified diet.

Health Related Services: Resident is assisted with self administration of prescription and non-prescription medications. Centrally stored resident medication records were reviewed and are given according to Physician directions. 30-Day supply of medications were reviewed.

Incident Medical and Dental: Resident has updated consultant assessments, Physician Reports, and COVID-19 vaccination cards on file.

Disaster Preparedness, and Emergency Intervention: Emergency Disaster Plan was reviewed. The plan shall be reviewed annually, updated as necessary, and maintained on file at the facility. First Aid Kit and Manual were observed. The last emergency drill was conducted on 12/28/24.

Emergency Intervention: Manual restraints are implemented by staff if needed via CPI techniques.

Per Title 22, California Code of Regulations, a deficiency was cited.

Exit interview conducted with Administrator Jasmine Thomas. A copy of the report and appeal rights were issued.

NAME OF LICENSING PROGRAM MANAGER: Lisa Hicks
NAME OF LICENSING PROGRAM ANALYST: Noemi Galarza
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 03/24/2025

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/24/2025

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 04/14/2025 09:20 AM - It Cannot Be Edited

Created By: Noemi Galarza On 03/24/2025 at 12:44 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 CNTR DR. ST 500
MONTEREY PARK, CA 91754

FACILITY NAME: PEOPLE'S CARE MCGEE	FACILITY NUMBER: 198603570
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 03/24/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

80087(a)

Building and Grounds

(a) The facility shall be clean, safe, sanitary and in good repair at all times for the safety and well-being of clients, employees and visitors. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation, the licensee did not comply with the section cited above; the north west hallway fire door does not close automatically when the smoke detectors are tested, which poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 04/21/2025
	Plan of Correction
1 2 3 4	Administrator agrees to submit picture/video proof of correction along with proof of completed work order invoice. If a POC extension is needed request must be submitted by POC due date.

Section Cited


	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

	Lisa Hicks
NAME OF LICENSING PROGRAM MANAGER:

	Noemi Galarza
NAME OF LICENSING PROGRAM ANALYST:

LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 03/24/2025

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/24/2025

LIC809 (FAS) - (06/04)

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