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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198603685
Report Date: 10/29/2024
Date Signed: 10/29/2024 04:14:44 PM

Document Has Been Signed on 10/29/2024 04:14 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:REMEDY HOUSE ADULT RESIDENTIAL FACILITYFACILITY NUMBER:
198603685
ADMINISTRATOR/
DIRECTOR:		ORDUNA, KELAFACILITY TYPE:
735
ADDRESS:5201 SOUTH STREETTELEPHONE:
(323) 853-9555
CITY:LAKEWOODSTATE: CAZIP CODE:
90712
CAPACITY: 4CENSUS: 4DATE:
10/29/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:40 PM
MET WITH:Lead DSP/Assistant Administrator Lakeisha TrotterTIME VISIT/
INSPECTION COMPLETED:
04:20 PM
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Licensing Program Analyst (LPA) Tyler Reyes conducted an unannounced annual visit using the CARE Tool. LPA met with Lead DSP/Assistant Administrator Lakeisha Trotter and explained the reason for the visit. Facility is licensed to serve 4 ambulatory only clients in the age range of 18 through 59.

A tour of the single-story facility included the 4 client bedrooms, 2 bathrooms, living room, dining area, kitchen, laundry room, front yard, backyard and attached garage. LPA observed the facility sketch posted in a broken frame near the front entrance. Assistant Administrator Trotter was unable to remove the frame. The frame has a crack in the glass stretching from the top corner of the frame to the bottom corner. LPA conducted the tour with Staff #1 (S1) and observed the following: sufficient food supplies for at least 2 days of perishables and 7 days of non-perishables were observed in the kitchen. Sharps are kept in a lock box. LPA Reyes observed with S1 Cascade Platinum Plus Dishwater Detergent Pods underneath the kitchen sink in an unlocked cabinet and accessible to (2) clients. Detergent pods were observed with S1 inside the box. LPA observed S1 remove the detergent pods and centrally store and lock in a cabinet in laundry room.Client #1 (C1-C4) medication was reviewed with Assistant Administrator Trotter. Medications are documented properly and given as prescribed. LPA observed with S1 and Assistant Administrator C1’s medication Wegovy Auto Injection 1mg inside an unlocked fridge in the laundry room and accessible to clients. Inside the Wegovy Auto Injection box was (3) injections. LPA observed Assistant Administrator Trotter lock fridge with medication inside. LPA reviewed (4) client and (5) staff files. First Aid kit is locked in the medication cabinet, and it is fully stocked with all required items including a current manual. Clean towels and extra clean linen were observed in the hallway cabinets. Dining and living room have sufficient lighting and sitting area. All bedrooms have all required furniture, lighting, and bedding. All showers were observed with non-skid material. Last Emergency Disaster Drill conducted on 10/17/24 Earthquake and 10/25/24 Fire.

**Continued LIC 809-C**


SUPERVISORS NAME: Fernando Fierros
LICENSING EVALUATOR NAME: Tyler Reyes
LICENSING EVALUATOR SIGNATURE: DATE: 10/29/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/29/2024
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 4
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: REMEDY HOUSE ADULT RESIDENTIAL FACILITY
FACILITY NUMBER: 198603685
VISIT DATE: 10/29/2024
NARRATIVE
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The water temperature was tested in both bathrooms and measured at 105.8 degrees F and 106.3 degrees F, which is within the required 105-120 degrees F. Fire extinguishers were observed in the kitchen and is fully charged. Smoke detectors were observed throughout the facility and in each room and were operable during the visit. A carbon monoxide was observed in the kitchen and was operable during the visit. The front yard and backyard are clean. There is a shaded area with seating in the backyard. No bodies of water were observed at the facility. Passageways and exits are free of obstruction. Medications are documented properly and given as prescribed.

Per California Code of Regulations, Title 22, and California Health and Safety Code, deficiencies observed during todays visit will be documented on the 809D.

Exit interview was held and a copy of the report was given to Lead DSP/Assistant Administrator Lakeisha Trotter

SUPERVISORS NAME: Fernando Fierros
LICENSING EVALUATOR NAME: Tyler Reyes
LICENSING EVALUATOR SIGNATURE:

DATE: 10/29/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/29/2024
LIC809 (FAS) - (06/04)
Page: 2 of 4
Document Has Been Signed on 10/29/2024 04:14 PM - It Cannot Be Edited


Created By: Tyler Reyes On 10/29/2024 at 03:28 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754

FACILITY NAME: REMEDY HOUSE ADULT RESIDENTIAL FACILITY
FACILITY NUMBER: 198603685

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/29/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
80087(a)
Building and Grounds
(a) The facility shall be clean, safe, sanitary and in good repair at all times for the safety and well-being of clients, employees and visitors.

This requirement is not met as evidenced by:
Deficient Practice Statement
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2
3
4
Based on observations, the licensee did not comply with the section cited above LPA observed the facility sketch posted in a broken frame near the front entrance.Assistant Administrator Trotter was unable to remove the frame. The frame has a crack in the glass stretching from the top corner of the frame to the bottom corner which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 10/30/2024
Plan of Correction
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Licensee to esnure facility postings in frames are in good repair. Licensee will remove broken frame and replace facility sktech posting in facility.
Type A
Section Cited
CCR
80087(g)
Building and Grounds
(g) Disinfectants, cleaning solutions, poisons, firearms and other items that could pose a danger if readily available to clients shall be stored where inaccessible to clients.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observtaions , the licensee did not comply with the section cited above LPA Reyes observed with S1 Cascade Platinum Plus Dishwater Detergent Pods underneath the kitchen sink in an unlocked cabinet and accessible to (2) clients. Detergent pods were observed with S1 inside the box which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 10/30/2024
Plan of Correction
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Licensee will esnure cleaning solutions that could pose a danger are stored inaccessible to clients. Licensee to provide In-Service training for all staff on cleaning solutions being inaccessible to clients. The In-Service Training will include list of attendees’ names and attendees’ signatures. Licensee will provide proof of In-Service Training to licensee by POC Due Date
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 Fierros
LICENSING EVALUATOR NAME:Tyler Reyes
LICENSING EVALUATOR SIGNATURE:
DATE: 10/29/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/29/2024


LIC809 (FAS) - (06/04)
Page: 3 of 4
Document Has Been Signed on 10/29/2024 04:14 PM - It Cannot Be Edited


Created By: Tyler Reyes On 10/29/2024 at 03:28 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754

FACILITY NAME: REMEDY HOUSE ADULT RESIDENTIAL FACILITY
FACILITY NUMBER: 198603685

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/29/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
80075(k)(1)
Health-Related Services
(k) The following requirements shall apply to medications which are centrally stored: (1) Medication shall be kept in a safe and locked place that is not accessible to persons other than employees responsible for the supervision of the centrally stored medication.

This requirement is not met as evidenced by:
Deficient Practice Statement
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3
4
Based on observations, the licensee did not comply with the section cited above LPA Reyes observed with S1 and Assistant Administrator Trotter C1’s medication Wegovy Auto Injection 1mg inside an unlocked fridge in the laundry room and accessible to clients. Inside the Wegovy Auto Injection box was (3) injections which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 10/30/2024
Plan of Correction
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Licensee will esnure medication is kept safe and locked and not accessible to clients. Licensee to provide In-Service training for all staff who assist clients with medications. The In-Service Training will include list of attendees’ names and attendees’ signatures. Licensee will provide proof of In-Service Training to licensee by POC Due Date
Section Cited
Deficient Practice Statement
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4
POC Due Date:
Plan of Correction
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4
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 Fierros
LICENSING EVALUATOR NAME:Tyler Reyes
LICENSING EVALUATOR SIGNATURE:
DATE: 10/29/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/29/2024


LIC809 (FAS) - (06/04)
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