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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198603593
Report Date: 11/06/2023
Date Signed: 11/06/2023 03:37:02 PM

Document Has Been Signed on 11/06/2023 03:37 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:VALLEY STAR RANCHO LOS AMIGOS CRTFACILITY NUMBER:
198603593
ADMINISTRATOR:HONORE-HARRELL, ALISHAFACILITY TYPE:
772
ADDRESS:7735 LEEDS STTELEPHONE:
(562) 719-2865
CITY:DOWNEYSTATE: CAZIP CODE:
90242
CAPACITY: 16CENSUS: 16DATE:
11/06/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:00 PM
MET WITH:Alisha Honore-HarrellTIME COMPLETED:
03:45 PM
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Licensing Program Analyst (LPA) Alma Gonzalez conducted an unannounced visit at the facility for the purpose of conducting the required annual inspection. LPA utilized the Compliance and Regulatory Enforcement (CARE) Tool to evaluate the facility. LPA Gonzalez met with Administrator Alisha Honore-Harrell and explained the purpose for the visit.

The facility is a Social Rehabilitation Facility licensed to serve 16 ambulatory only clients. This facility is considered a short-term crisis treatment program.

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.

The program site is clean, safe, sanitary and in good repair. All passageways are free from obstruction. Disinfectants, cleaning solutions and poisons are inaccessible to clients and are locked. All fire extinguishers are fully charged. Facility has a sprinkler fire system throughout the facility. Carbon monoxide detector(s) observed. All bathrooms were observed to be clean. Clients are provided the required hygiene items. Client bedrooms had the required furniture for comfort and safety and had sufficient lighting. Common areas included the activity rooms, television rooms and dining areas. The common areas appeared properly furnished. There is sufficient lighting throughout the facility. There are no large bodies of water on the premises such as pools. The facility grounds are well groomed and there were no hazards observed. Hot water temperature measured 118 F, which is within the required 105 - 120 degrees. LPA toured the kitchen which appeared clean and the appliances and fixtures functional. The kitchen was observed for the ability to



(Continued to LIC 809-C)
SUPERVISORS NAME: Wei Siew Ho
LICENSING EVALUATOR NAME: Alma Gonzalez
LICENSING EVALUATOR SIGNATURE: DATE: 11/06/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/06/2023
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: VALLEY STAR RANCHO LOS AMIGOS CRT
FACILITY NUMBER: 198603593
VISIT DATE: 11/06/2023
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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.

Sharps are kept locked and inaccessible to clients. The facility maintains a comfortable temperature in each room. The First Aid kit is kept in the medication room and it is fully stocked with all required items including a current manual. The last fire drill was conducted on 10/24/2023 and the disaster/earthquake drill was conducted on 10/19/2023.

LPA reviewed medication for 3 clients and observed that medications are documented properly and given as prescribed. LPA reviewed 3 client and 3 staff records.

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 Administrator Alisha Honore-Harrell.
SUPERVISORS NAME: Wei Siew Ho
LICENSING EVALUATOR NAME: Alma Gonzalez
LICENSING EVALUATOR SIGNATURE:

DATE: 11/06/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/06/2023
LIC809 (FAS) - (06/04)
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