<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198603593
Report Date: 10/15/2024
Date Signed: 10/15/2024 01:34:16 PM

Document Has Been Signed on 10/15/2024 01:34 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
MONTEREY PARK ASC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754
FACILITY NAME:VALLEY STAR RANCHO LOS AMIGOS CRTFACILITY NUMBER:
198603593
ADMINISTRATOR/
DIRECTOR:
HONORE-HARRELL, ALISHAFACILITY TYPE:
772
ADDRESS:7735 LEEDS STTELEPHONE:
(562) 719-2865
CITY:DOWNEYSTATE: CAZIP CODE:
90242
CAPACITY: 16CENSUS: 15DATE:
10/15/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:29 AM
MET WITH:Alisha Honore AdministratorTIME VISIT/
INSPECTION COMPLETED:
01:45 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
Licensing Program Analysts (LPAs) Christian Gutierrez and Myra Cota conducted the annual inspection using the Compliance and Regulatory Enforcement (CARE) tools. LPA met Administrator Alisha Honore at approximately 10:30 AM and explained reason for visit. The facility is a Social Rehabilitation Facility licensed to serve 16 ambulatory clients of which 2 may be non-ambulatory. 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.

LPA toured the facility and observed the following: Each client bedroom has the required furniture and bedding. There is extra clean linen and towels in storage room on first floor. Facility has a sprinkler fire system throughout the facility. Carbon monoxide detector(s) observed. There are seven (7) fire extinguishers throughout the building fully charged. Cleaning supplies and toxic substances are inaccessible to clients in a locked storage rooms on both floors. 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. 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/earthquake drill was conducted in September of 2024. There are no firearms or weapons stored at the facility. The hot water temperature in the bathrooms were measured between the required range of 105-120 degrees F. The facility does not have a swimming pool or bodies of water on the premises There is a shaded seating area for the residents located in the backyard.

SUPERVISORS NAME: Tony Vasallo
LICENSING EVALUATOR NAME: Christian Gutierrez
LICENSING EVALUATOR SIGNATURE: DATE: 10/15/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/15/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 2
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK ASC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754
FACILITY NAME: VALLEY STAR RANCHO LOS AMIGOS CRT
FACILITY NUMBER: 198603593
VISIT DATE: 10/15/2024
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
Five (5) staff files were reviewed and included Criminal clearance record, CPR/training, and health screening with TB. Four (4) client files were reviewed and included physicians report, TB clearance and medication list. Infectious control plan was reviewed. Five (5) client medications were reviewed. Medications are centrally stored and locked MAR log is used.

No deficiency was observed during today’s visit. Exit interview was conducted with Administrator and a copy of report was provided.

SUPERVISORS NAME: Tony Vasallo
LICENSING EVALUATOR NAME: Christian Gutierrez
LICENSING EVALUATOR SIGNATURE:

DATE: 10/15/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/15/2024
LIC809 (FAS) - (06/04)
Page: 2 of 2