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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198603634
Report Date: 08/05/2024
Date Signed: 08/05/2024 12:24:40 PM


Document Has Been Signed on 08/05/2024 12:24 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:ANEW DAWN ADULT LIVINGFACILITY NUMBER:
198603634
ADMINISTRATOR:DUFRENNE, PATRIA MARAVILLAFACILITY TYPE:
735
ADDRESS:4340 LOCKWOOD AVETELEPHONE:
(323) 426-9123
CITY:LOS ANGELESSTATE: CAZIP CODE:
90029
CAPACITY:94CENSUS: 76DATE:
08/05/2024
TYPE OF VISIT:Case Management - Legal/Non-complianceUNANNOUNCEDTIME BEGAN:
09:27 AM
MET WITH:Patria DufrenneTIME COMPLETED:
12:30 PM
NARRATIVE
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Licensing Program Analyst (LPA) Tyler Reyes conducted a Case Management - Legal/Non-compliance visit. On 10/11/23 a Non-compliance conference was held and the licensee was made aware that the department would make regular visits to the facility.

During today's visit, LPA collected copies of Staff and Client Rosters and conducted a tour of the facility. LPA observed the following:
  • The facility is operating within the approved capacity.
  • All outdoor and indoor passageways are free of obstruction.
  • There are no large bodies of water on the premises such as pools.
  • Disinfectants and cleaning supplies are inaccessible to clients.
  • Facility maintains a comfortable temperature inside.
  • There is sufficient lighting throughout the facility.
  • Freezers and refrigerators are clean and operating properly.
  • There was sufficient staff present during the visit.
  • Exterior of facility was cleared of excess garbage.
  • Inspected kitchen and supply of food. There are sufficient supply of 2 day perishables and 7 day non- perishables.
  • Inspected Rooms: 202, 201, 207, 219, 208, and 228.
  • Signal systems was fully operable.
  • Emergency supply of water and food were sufficient.

(Continued 809c)
SUPERVISOR'S NAME: Fernando FierrosTELEPHONE: (323) 981- 3981
LICENSING EVALUATOR NAME: Tyler ReyesTELEPHONE: (323) 981-3306
LICENSING EVALUATOR SIGNATURE:
DATE: 08/05/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/05/2024
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 3


Document Has Been Signed on 08/05/2024 12:24 PM - It Cannot Be Edited

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: ANEW DAWN ADULT LIVING
FACILITY NUMBER: 198603634

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/05/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
08/12/2024
Section Cited
CCR
85072(b)(12)

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85072 Personal Rights(b) The licensee shall insure that each client is accorded the following personal rights.(12)To move from the facility in accordance with the terms of the Admission Agreement.
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Administrator will conduct in-service training for all facility staff and security regarding all clients personal rights. Training material and Sign-In sheet for participants will be emailed to LPA by POC due date.
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This requirement was not met as evidence by the following: LPA was informed by C1 and C2 that security has used a hand held metal detector wand on them before entering facility, which poses a Personal Rights risk to the persons in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Fernando FierrosTELEPHONE: (323) 981- 3981
LICENSING EVALUATOR NAME: Tyler ReyesTELEPHONE: (323) 981-3306
LICENSING EVALUATOR SIGNATURE:
DATE: 08/05/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/05/2024
LIC809 (FAS) - (06/04)
Page: 3 of 3


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: ANEW DAWN ADULT LIVING
FACILITY NUMBER: 198603634
VISIT DATE: 08/05/2024
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  • Hot water supply was measured and measured between 105-120 degrees F in the following rooms 202, 201, 207, 219, 208, and 228.
  • Bathrooms were inspected and appeared sanitary.
  • Lighting was sufficient in rooms and hallways.
  • Centrally stored medicines are kept in a safe and locked place.

During an interview LPA Reyes had C1 and C2 it was stated that security has used a hand held metal detector wand on them before entering facility, which poses a Personal Rights risk to the persons in care.

LPA Reyes conducted (7) client and (2) staff interviews.



According to the California Code of Regulations Title 22 regulations. LPA observed the following deficiencies and issued a citation.

An exit interview was conducted and a copy of the Report and Appeal Rights were provided to Administrator Patria Dufrene.
SUPERVISOR'S NAME: Fernando FierrosTELEPHONE: (323) 981- 3981
LICENSING EVALUATOR NAME: Tyler ReyesTELEPHONE: (323) 981-3306
LICENSING EVALUATOR SIGNATURE:

DATE: 08/05/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/05/2024
LIC809 (FAS) - (06/04)
Page: 2 of 3