198603721-2-14-2025-28-AS-THEA-DDVUYP-20250214150016

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 198603721
Report Date: 02/14/2025
Date Signed: 02/14/2025 03:01:08 PM

Document Has Been Signed on 02/14/2025 03:01 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:	CRT PROGRAMS - DOWNEY		FACILITY NUMBER:	198603721
ADMINISTRATOR/ DIRECTOR:	STORY, LAWRENCE		FACILITY TYPE:	772
ADDRESS:	7765 LEEDS ST RTP-E		TELEPHONE:	(310) 709-7355
CITY:	DOWNEY	STATE: CA	ZIP CODE:	90242
CAPACITY: 16		CENSUS: 10	DATE:	02/14/2025
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	11:46 AM
MET WITH:	Karen Gordley - Program Director		TIME VISIT/ INSPECTION COMPLETED:	03:15 PM

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Licensing Program Analyst (LPA) Tena Herrera conducted the required annual inspection. LPA arrived unannounced and met with Program Director Karen Gordley who assisted with the visit. The purpose for today’s visit was explained.

The 2 story facility is a short-term Crisis Residential Program licensed to serve 16 Ambulatory and 2 Non-Ambulatory clients ages 18-59.

A tour of the facility includes: First Floor: front desk office, lobby, dining area, kitchen, laundry room, 2 client bedrooms, staff office, group room, mud room (with restroom and shower), 1 restroom, 1 shower room, storage rooms, medication room, electrical room, elevator, and outdoor patio area. Second Floor: elevator, storage room, laundry, living room area, electrical room, 6 bedrooms, 3 restrooms, 3 shower rooms, tech station, laundry room, staff lounge, and staff restroom.

LPA utilized the Compliance and Regulatory Enforcement (CARE) tools for the visit today and observed the following:

Infection Control: The facility has a valid Infection Control Plan and have sufficient PPE supplies.

Physical Plant & Environment Safety: Clients’ bedrooms were checked and closet/drawer space to accommodate each client comfortably was available. Hygiene products are readily available and stored in a storage room. The hot water temperature was measured throughout the facilities client shower rooms and measured within the required range of 105-120 degrees. All storage areas for cleaning solutions, toxins, knives, and hazardous items are centrally stored and kept locked and inaccessible to clients. Smoke detectors and carbon monoxide detectors are operable and in compliance, facility has an emergency sprinkler system throughout the facility. The fire extinguishers were observed and fully charged.
Staffing: The facility has sufficient staffing and training's are documented electronically on Relias.
Personnel Records-Training: Staff files are maintained electronically, LPA reviewed 4 staff files during todays visit. 1 staff file was missing training's from file, 2 staff were missing first-aid training/certificates, 1 staff was missing their health-screening/TB test. All staff are finger print cleared. (Continued on LIC809-C)

SUPERVISORS NAME: David Sicairos
LICENSING EVALUATOR NAME: Tena Herrera
LICENSING EVALUATOR SIGNATURE:	DATE: 02/14/2025

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/14/2025

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: 02/14/2025

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Client Rights-Information: Client personal rights and reporting posters are posted in lobby area.
Client Records-Incident Reports: The client files are stored electronically, LPA reviewed 5 client files during visit and each had the following - Admission Agreements, Identification & Emergency Information, current Physician's Report, Appraisal Needs & Services Plan.
Food Service: The kitchen was observed for the ability to prepare and serve food. LPA observed an appropriate food supply with no issues. This facility has meals catered to facility every 2 days. Emergency food was also observed.
Health Related Service: Medication is centrally stored in the Medication Room, LPA reviewed 5 clients medications with no issues observed.
Disaster Preparedness: The facility has an Emergency Disaster Plan with contact numbers and at least 2 relocation sites. Last fire drill was conducted on 12/31/24. LPA observed emergency evacuation chairs at each stairwell.

Per California Code of Regulations, Title 22, and California Health and Safety Code, deficiencies observed during today’s visit will be documented on the LIC809-D page.

Exit interview was held and a copy of the report and appeal rights will be emailed provided to Administrator Karen Gordley.

SUPERVISORS NAME: David Sicairos
LICENSING EVALUATOR NAME: Tena Herrera
LICENSING EVALUATOR SIGNATURE:	DATE: 02/14/2025

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/14/2025

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 02/14/2025 03:01 PM - It Cannot Be Edited

Created By: Tena Herrera On 02/14/2025 at 02:35 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: CRT PROGRAMS - DOWNEY	FACILITY NUMBER: 198603721
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 02/14/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

HSC

1562.5(d)

Other Provisions

(d) All administrators of adult residential and program directors of social rehabilitation facilities licensed on or before January 1, 1994, shall complete the training by December 31, 1994, and every two years thereafter. Newly employed administrators and program directors shall complete training within six months after commencing employment. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on record review, the licensee did not comply with the section cited above as administrator could not furnish proof of any training, which poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 03/03/2025
	Plan of Correction
1 2 3 4	Administrator to complete all required training and email LPA proof of completion of trainings via email by POC due date. tena.herrera@dss.ca.gov

Type B

Section Cited

CCR

81075(f)

Health-Related Services

(f) Staff responsible for providing direct care and supervision shall receive training in first aid from persons qualified by agencies including but not limited to the American Red Cross. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on record review, the licensee did not comply with the section cited above as during staff file review there were 2 staff that were missing their first-aid certificate/training, which poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 03/03/2025
	Plan of Correction
1 2 3 4	Administrator to submit proof of completion of first-aid training and a copy of the first-aid certificates for the 2 staff (S1 and S2) by POC due date via email (tena.herrera@dss.ca.gov).

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:

David Sicairos

LICENSING EVALUATOR NAME:

Tena Herrera

LICENSING EVALUATOR SIGNATURE:

DATE: 02/14/2025

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/14/2025

LIC809 (FAS) - (06/04)

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