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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198603721
Report Date: 01/08/2024
Date Signed: 01/08/2024 11:40:09 AM

Document Has Been Signed on 01/08/2024 11:40 AM - 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:CRT PROGRAMS-DOWNEYFACILITY NUMBER:
198603721
ADMINISTRATOR:GHODSIAN, LILLIANFACILITY TYPE:
772
ADDRESS:7765 LEEDS ST RTP-ETELEPHONE:
(310) 709-7355
CITY:DOWNEYSTATE: CAZIP CODE:
90242
CAPACITY: 16CENSUS: 0DATE:
01/08/2024
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Dr. Ghodsian and Lillian GhodsianTIME COMPLETED:
12:00 PM
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Licensing Program Analyst (LPA) Elizabeth Irra conducted an announced pre-licensing visit. LPA met with Dr. Ghodsian and Lillian Ghodsian and discussed the purpose of today's visit. Also present, Clarisa Lissa (Administrator) and Abraham Cabrera (general contractor). Component 3 was conducted during today's visit. Per Applicant, this facility is in the process of becoming Medi-Cal certified (Department of Mental Health Program/DMH).

This facility is has a fire clearance for (2) non-ambulatory beds (room #1) and (14) ambulatory beds (total capacity of 16). LPA tour facility grounds. This is a two-story building. First floor consists of: lobby, living room/activity room/dining room, client resource station, staff station, medication room, laundry room, (2) bedrooms, (3) client bathrooms and (2) client showers, group/visitation office, hygiene room and storage room. Water fountain with filtration were also observed. Second floor consists of: lobby/dining area/activity room, client resource station, clinician office, staff patio, staff kitchen, staff lactation room, laundry room, boiler/mud room, (6) bedrooms, (2) client showers, (3) client bathrooms, (1) staff bathroom. Water fountain with filtration were also observed.

Pre-Licensing Domains:
Infection Control: There is an Infection Control Plan (LIC 9282) in place.
Physical Plant and Environmental Safety: Carbon Monoxide detectors observed. Fire Alarms observed. Fire extinguishers observed (last service date 01/02/24). Sprinkler system observed. There is telephone service on premises. The facility is clean, safe, sanitary and in good repair. Passage ways and stairways are free from obstruction. There are no more than (2) clients for each bedroom. Disinfectants will be stored and locked away from clients. Clients rooms have the required furnishing and linens. Client rooms also have a signal system which was tested and operational. Water temperature measured at 111.0*.

Refer to LIC 809C for the continuation of this report.
SUPERVISORS NAME: Tony Vasallo
LICENSING EVALUATOR NAME: Elizabeth Irra
LICENSING EVALUATOR SIGNATURE: DATE: 01/08/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/08/2024
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: CRT PROGRAMS-DOWNEY
FACILITY NUMBER: 198603721
VISIT DATE: 01/08/2024
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 Operational Requirements: Planned activities are posted in the lobby and client common areas. Outdoor shaded activity space observed.
Client Rights-Information: Client Rights and Visiting Policy are posted in the lobby and client common areas. Facility has client resources stations.
Food Service: Per Applicant, all food will be catered/provided by an outside vendor (contract pending). Applicant to ensure a written agreement for food service is in place as this will be reviewed during annual inspections. However, kitchen is equipped and has the plates, cups and utensils. Facility will be providing the drinks and snacks.
Incidental Medical Services: Per Applicant, facility will work with Home Health Agencies (if and when applicable).
Health and Related Services: This facility has a fire clearance for (2) non-ambulatory beds (room #1) and (14) ambulatory beds (total capacity of 16). Medication will be kept stored and locked inside the locked medication room.
Disaster Preparedness: There is an Emergency Disaster Plan (LIC 610D) in place.

The following remains pending:
Health and Safety (H&S) Code 1565(f)(1) (1) An evacuation chair at each stairwell in a residential facility serving adults, on or before July 1, 2021.

Exit interview conducted and a copy of this report was provided to Dr. Ghodsian and Lillian Ghodsian.
SUPERVISORS NAME: Tony Vasallo
LICENSING EVALUATOR NAME: Elizabeth Irra
LICENSING EVALUATOR SIGNATURE:

DATE: 01/08/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/08/2024
LIC809 (FAS) - (06/04)
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