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

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198603646
Report Date: 05/30/2023
Date Signed: 05/30/2023 01:57:08 PM

Document Has Been Signed on 05/30/2023 01:57 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:INTEGRATED LIFE LLCFACILITY NUMBER:
198603646
ADMINISTRATOR:DE LEON, CORINAFACILITY TYPE:
775
ADDRESS:10329 ARTESIA BOULEVARDTELEPHONE:
(562) 202-9942
CITY:BELLFLOWERSTATE: CAZIP CODE:
90706
CAPACITY: 30CENSUS: 0DATE:
05/30/2023
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
10:10 AM
MET WITH:Corina Deleon - Executive DirectorTIME COMPLETED:
01:11 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 Analyst (LPA) Bennette Pena conducted an announced Pre-Licensing facility Evaluation visit. LPA met with Applicants Corina Deleon, Executive Director and Catherine Bennage, Director of Programs & Services who assisted with the visit. The facility is a freestanding building, an office type property within the city of Bellflower. The building faces high traffic street on Artesia Blvd./Woodruff Ave. All clients at the program will receive case management services provided by Harbor Regional Center. LPA utilized the Compliance and Regulatory Enforcement (CARE) tools for the visit today and the following was inspected during the evaluation with Corina Deleon and Catherine Bennage and determined to be compliant with the California Code of Regulations Title 22.

The following are observed:

Physical Plant & Environment Safety:

  • It consists of fifteen (15) rooms, two (2) bathrooms for men/women, lobby/activity room, dining room, kitchen and open parking space.
  • There are sixty-six (66) lockers available for clients us, located in the lobby/activity room.
  • The program site has a universal screening area located in the entrance.
  • Each bathroom for men and women has two (2) stalls.
  • The program site provides gym/work-out room, activity room and computer room for clients' use.
  • There is a relaxation room for rest periods available to clients and staff.
  • Smoke detectors and carbon monoxide detectors were observed throughout the facility and were tested and operable.
  • The facility does have auditory device that will alert staff to monitor exits.
  • There is a separate room designated for ill clients or first-aid treatment.
  • There are four (4) fire extinguishers observed to be fully charged and recently serviced.
  • Cleaning supplies were separate from where food supplies are stored.
  • The walls, ceilings, floors, window screens and areas around the facility were clean and in good repair.
  • There are two (2) supply/storage rooms to house the PPE supplies, cleaning solutions and disinfectants. Both supply rooms are locked and inaccessible to clients.
  • Doors, exits, hallways, and passageways were clear and free of obstruction.
  • The front yard/parking area was observed to be clean and free of debris.
  • No pools or bodies of water were observed in or around the building.
  • There are no firearms present at the facility.
  • The program site has a video camera monitor system outside and around the building. There are no cameras inside.
  • There is no outdoor patio set up but in case of events, they will put up tables, chairs, patio umbrellas to keep the area shaded and furnished for outdoor use.
  • Equipment and supplies for indoor activities was observed to be made available on site.
  • Hot water temperature was tested at 108.6 deg F and 109 deg F which is within the required 105F - 120F.


***CONTINUED ON LIC 809-C*****
SUPERVISORS NAME: David Sicairos
LICENSING EVALUATOR NAME: Bennette Pena
LICENSING EVALUATOR SIGNATURE: DATE: 05/30/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/30/2023
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
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: INTEGRATED LIFE LLC
FACILITY NUMBER: 198603646
VISIT DATE: 05/30/2023
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
Operational Requirements:
  • A current Plan of Operation was reviewed. The Infection Control Plan has been added to the Plan.
  • The facility has a fire clearance from the City of Whittier Fire Department for a capacity of twenty (2) ambulatory and ten (10 non ambulatory and zero (0) bedridden for a total capacity of thirty (30) clients.
  • Liability Insurance is valid in the amount of $2,000,000.00 (aggregate limit) and $1,000,000.00 (each incident limit) and will expire on 8/16/2023.
  • The program has a computer room, and provides three (3) laptop computers and four (4) tablets for clients use.
  • Clients' cash resources will be maintained in a double locked cabinet located in the Program Manager's office.
  • The plan of operation indicates that staff will complete initial training, beginning at the time of hire. Staff will receive training within the first ten (10) days of employment.
  • Two (2) operating telephones were observed and tested by LPA on the premises. Telephones are easily accessible and available for clients' use.

Personnel Records-Training:
  • Criminal Record clearances/exemptions are maintained at the program site.
  • A plan of coverage in absence of the Administrator is in place, Director of Programs & Services will step-in the absence od the Director of Services, and vice versa.

Client Records-Incident Reports:

  • Employee and Client files will be maintained and locked in a cabinet located in the kitchen.

Client Rights-Information:
  • The program site has adequate furnishings and equipment to meet the clients' needs.
  • Visitors policy will be posted in areas accessible to clients and their visitors.

***CONTINUED ON LIC 809-C*****
SUPERVISORS NAME: David Sicairos
LICENSING EVALUATOR NAME: Bennette Pena
LICENSING EVALUATOR SIGNATURE:

DATE: 05/30/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/30/2023
LIC809 (FAS) - (06/04)
Page: 2 of 3
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: INTEGRATED LIFE LLC
FACILITY NUMBER: 198603646
VISIT DATE: 05/30/2023
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
Food Service:
  • Meals will be stored and prepared in a safe manner, necessary to meet the needs of clients.
  • Toxic substances are stored in food storerooms and kitchen cabinets.
  • Food storage and preparation areas, which include pantries, cupboards, drawers and counters were observed to be clean and appropriate for food preparation. Appliances such as a microwave, refrigerator and stove were observed to be clean and operating properly.
  • As the program runs 2x a day, 4 hours at a time, they will not provide lunch, only snacks. Clients are welcome to bring their own lunch and warm the food in the kitchen if they prefer.
  • The refrigerator was observed to be at 45 degrees Fahrenheit and the freezer at 0 degrees Fahrenheit.
Health Related Services:
  • First Aid supply was observed and is kept in a double locked cabinet, which included all required supplies.
  • List of emergency contacts such as Police, Fire Dept. or paramedic unit was reviewed. The program site has one medical resource available to be called at all times.
  • A double locked cabinet for central storage of medications was observed in the Program Manager's office.

Disaster Preparedness:

  • The facility has a complete Emergency and Disaster Preparedness Plan that includes, EVAC Procedures, Transportation arrangements, Location of all utility shut-off valves and instructions for use
  • The program has a contact information list of local emergency response personnel, clients authorized representative or local emergency contact name.


The Component III orientation was also conducted during today's visit. No outstanding or pending items were observed by LPA requiring additional pre-licensing visits.

LPA will notify the assigned Centralized Applications Bureau (CAB) Analyst of the completed pre-licensing facility evaluation visit conducted, which included the Component III orientation.

Exit interview conducted and a copy of this report was provided to the Applicant Corina Deleon, Executive Director.

SUPERVISORS NAME: David Sicairos
LICENSING EVALUATOR NAME: Bennette Pena
LICENSING EVALUATOR SIGNATURE:

DATE: 05/30/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/30/2023
LIC809 (FAS) - (06/04)
Page: 3 of 3