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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198603646
Report Date: 05/21/2024
Date Signed: 05/21/2024 04:13:27 PM

Document Has Been Signed on 05/21/2024 04:13 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/
DIRECTOR:		DE LEON, CORINAFACILITY TYPE:
775
ADDRESS:10329 ARTESIA BOULEVARDTELEPHONE:
(562) 202-9942
CITY:BELLFLOWERSTATE: CAZIP CODE:
90706
CAPACITY: 30CENSUS: 13DATE:
05/21/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:09 PM
MET WITH:Catherine Bennage - Program DirectorTIME VISIT/
INSPECTION COMPLETED:
04:30 PM
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Licensing Program Analyst (LPA) Tena Herrera conducted an unannounced visit for an Annual Inspection. LPA met with Catherine Bennage (Director of Programs & Services), and the purpose for the visit was explained. The facility is licensed to serve 30 Adults ages 18, which (10) may be non-ambulatory.

This is a single- story facility located in Bellflower, Ca. A tour of the facility includes: Lobby with Client Lockers, Storage Room, Locked Management Office (where files are kept), Art Room, Computer Lab, Fitness Room, Leisure Room (and Kitchen), Conference Room, Program Coordinator Office, Staff Break Room, Staff Office, Relaxation Room, Cleaning Supplies/Laundry Room, Additional Storage Room and Mens/Womens restroom with stalls.

LPA utilized the Compliance and Regulatory Enforcement (CARE) tools for the visit today and observed the following:
Infection Control: The facility staff are using appropriate hand hygiene and cleaning/disinfecting throughout the day. Facility has sufficient PPE supplies and has an Infection Control Plan.
Physical Plant & Environment Safety: Smoke detectors and carbon monoxide detectors are operable and in compliance. The fire extinguishers were observed and are fully charged. No bodies of water were observed at the facility. The hot water temperature was tested in the kitchen and measured within the required range of 105-120 degrees. All storage areas for cleaning solutions, toxins, poisons and hazardous items are stored in a secured/locked storage closet and inaccessible to clients. Clients have a water station available in the kitchen and are provided water bottles. The facility appears to be clean safe and sanitary.
Operational Requirements: The facility has the appropriate fire clearance. Staff are knowledgeable on their reporting requirements.
(Continued on 809-C)
SUPERVISORS NAME: David Sicairos
LICENSING EVALUATOR NAME: Tena Herrera
LICENSING EVALUATOR SIGNATURE: DATE: 05/21/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/21/2024
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: INTEGRATED LIFE LLC
FACILITY NUMBER: 198603646
VISIT DATE: 05/21/2024
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Staffing: There appears to be sufficient staffing at all times in the facility. There are at least 2 staff members on duty any time there are clients in the facility.
Personnel Records-Training: Staff files were readily available during visit. LPA reviewed 5 staff files, each file reviewed have criminal record clearance, current First Aid/CPR/AED/CPI and sufficient on-going training. Program Director the education, proper training and experience to meet the requirements.
Client Records-Incident Reports: Client files are kept in a secure location and have the following documents in their files - Admission Agreements, Identification & Emergency Information, current Physician's Report, Consent Forms, and Appraisal Needs & Services Plan. LPA reviewed 5 client records no issues.
Client Rights-Information: Client Rights Poster is posted within the facility.
Food Service: Pesticides and other similar toxic substances are not stored with the food. Clients bring their lunches and staff will provide snack to clients.
Health Related Services: Clients with incontinence at the facility are kept clean and dry, and the facility is free of any odors.
Incidental Medical & Dental: Staff have proper training documented within the personnel files and files are reviewed annually.
Disaster Preparedness: There is an Emergency Disaster Plan with contact numbers and relocation sites.
Emergency Intervention: Clients at this facility have not needed the use of restraints or the use de-escalation techniques, however, staff do maintain a valid CPI certificate.

Per California Code of Regulations, Title 22, and California Health and Safety Code, there were no deficiencies observed during today’s visit.

Exit interview was held and a copy of the report was provided to Catherine Bennage.
SUPERVISORS NAME: David Sicairos
LICENSING EVALUATOR NAME: Tena Herrera
LICENSING EVALUATOR SIGNATURE:

DATE: 05/21/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/21/2024
LIC809 (FAS) - (06/04)
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