198603721-1-5-2026-28-AS-DKOI-DQ32SE-20260105163900

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 198603721
Report Date: 01/05/2026
Date Signed: 01/05/2026 04:40:56 PM

Document Has Been Signed on 01/05/2026 04:40 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:	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:	01/05/2026
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	10:55 AM
MET WITH:	Karen Gordley, Program Director		TIME VISIT/ INSPECTION COMPLETED:	04:50 PM

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Licensing Program Analyst (LPA) Daniel Konishi 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.

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

Infection Control: Infection control practices and Personal Protective Equipment (PPEs) were observed. The facility has an Infection Control Plan in place. Common area surfaces are being cleaned and disinfected on a regular basis. Bathrooms have soap and paper towels. Staff are adhering to infection control requirements.

Physical Plant & Environment Safety: A tour of the facility includes: First Floor: front desk office, lobby, dining area, kitchen, laundry room, staff office, group room, mud room (with restroom and shower), one (1) restroom, one (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, six (6) bedrooms, three (3) restrooms, three (3) shower rooms, tech station, laundry room, staff lounge, and staff restroom. 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. Extra linens and blankets are stored in the Laundry room. The hot water temperature was measured throughout the facilities client shower rooms and measured between 105.4 degrees F to 117.8 degrees F which is within the required range of 105-120 degrees.

NAME OF LICENSING PROGRAM MANAGER: David Sicairos
NAME OF LICENSING PROGRAM ANALYST: Daniel Konishi
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 01/05/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/05/2026

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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California Health & Human Services Agency

California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:

Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.

Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)

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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
MONTEREY PARK ASC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754

FACILITY NAME: CRT PROGRAMS - DOWNEY	FACILITY NUMBER: 198603721
	VISIT DATE: 01/05/2026

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Physical Plant & Environment Safety: 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 six (6) fire extinguishers were observed and fully charged.

Operational Requirements: The fire clearance is in place. The facility has a valid Liability Insurance policy in place. Fire Drill was last conducted on 12/31/2025.

Staffing: A total of thirty-three (33) staff provide care and supervision to the clients. Staff employed are over the age of 18 and have criminal background clearance, fingerprint cleared, have the required training and are associated to the facility.

Personnel Records-Training: Staff files are maintained electronically. LPA reviewed five (5) staff files during today’s visit, files reviewed contained the following: Personnel Record, Criminal Background Clearance, First-Aid/CPR/AED, Employee Rights, and sufficient on-going training.

Client Records-Incident Reports: The client files are stored electronically, LPA reviewed five (5) client files during visit and each had the following – Face Sheet, Admission Agreements, Physician's Report, TB Clearance, Ambulatory status, Treatment Plan, and Personal Rights.

Client Rights-Information: Client personal rights and reporting posters are posted in lobby area.

Food Service: The kitchen was inspected and the food preparation area and storage areas were observed to be clean and sanitary. A seven (7) day supply of non-perishable food and two (2) day supply of perishable foods were observed in the kitchen. There are no clients that have a modified diet.

Health Related Service: Medication is centrally stored in the Medication Room, LPA reviewed five (5) clients’ medications with no issues observed. Centrally stored medications are kept in a safe in a locked place and inaccessible to clients in care. Medications are given according to Physician directions. LPA reviewed the First Aid Kit which had all the required items.

Incidental Medical Services: Based on record review and staff interview, there is a client under restricted health conditions and proper staff training for restricted health conditions are in file.

NAME OF LICENSING PROGRAM MANAGER: David Sicairos
NAME OF LICENSING PROGRAM ANALYST: Daniel Konishi
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 01/05/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/05/2026

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
MONTEREY PARK ASC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754

FACILITY NAME: CRT PROGRAMS - DOWNEY	FACILITY NUMBER: 198603721
	VISIT DATE: 01/05/2026

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Disaster Preparedness: The facility has an Emergency Disaster Plan with contact numbers and at least two (2) relocation sites. Last fire drill was conducted on 12/31/25. LPA observed emergency evacuation chair at the stairway.

Per California Code of Regulations, Title 22, and California Health and Safety Code, No deficiencies observed during today’s visit. Exit interview was held and a copy of the report was provided to Administrator Karen Gordley.

NAME OF LICENSING PROGRAM MANAGER: David Sicairos
NAME OF LICENSING PROGRAM ANALYST: Daniel Konishi
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 01/05/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/05/2026

LIC809 (FAS) - (06/04)

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