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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198603721
Report Date: 11/22/2024
Date Signed: 11/22/2024 03:40:29 PM

Document Has Been Signed on 11/22/2024 03:40 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
GREATER LA AC/SC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754
FACILITY NAME:CRT PROGRAMS - DOWNEYFACILITY NUMBER:
198603721
ADMINISTRATOR/
DIRECTOR:		STORY, LAWRENCEFACILITY TYPE:
772
ADDRESS:7765 LEEDS ST RTP-ETELEPHONE:
(310) 709-7355
CITY:DOWNEYSTATE: CAZIP CODE:
90242
CAPACITY: 16CENSUS: 5DATE:
11/22/2024
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:32 AM
MET WITH:Dr.Ghodsian and Nicole Nehoraoff TIME VISIT/
INSPECTION COMPLETED:
12:45 PM
NARRATIVE
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Licensing Program Analyst (LPA) Kimberly Ramirez and LPA Luis De Leon conducted a Case Management Visit-Deficiencies on 11/22/2024, stemming from initial complaint investigation conducted on 11/22/2024. LPA’s were greeted by Dr. Ghodsian and Nicole Nehoraoff and explained the purpose of the visit. LPA’s gained entry into the facility at 10:00 am.

Case Management-Deficiencies findings:

On 11/22/24, LPA Ramirez observed janitorial cart with cleaning supplies, cleaning solutions, and disinfectants accessible to clients, in Hygiene room. LPA’s observed Hygiene room door to be accessible and not contain a locking mechanism. LPA’s observed cleaning solutions in laundry room, such as laundry detergents, to be accessible to clients. During record review, LPA’s observed documentation that indicated three (3) out of the five (5) clients in care, have a history of self-harm behaviors.



Per Title 22, Buildings and Grounds- 81087(l)- The licensee shall ensure that items which could pose a danger if readily available to clients, including but not limited to disinfectants, cleaning solutions, and poisons are stored where inaccessible to clients.

Based on these observations and records reviewed, one (1) violation was cited during visit. Exit interview was conducted and a copy of this report was provided.
SUPERVISORS NAME: Tony Vasallo
LICENSING EVALUATOR NAME: Kimberly Ramirez
LICENSING EVALUATOR SIGNATURE: DATE: 11/22/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/22/2024
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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Document Has Been Signed on 11/22/2024 03:40 PM - It Cannot Be Edited


Created By: Kimberly Ramirez On 11/22/2024 at 01:57 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: 11/22/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
11/25/2024
Section Cited
CCR
81087(l)

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(l) The licensee shall ensure that items which could pose a danger if readily available to clients, including but not limited to disinfectants, cleaning solutions, and poisons are stored where inaccessible to clients.

This requirement was not met as evidence by:
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*Licensee removed and secured cleaning supplies, cleaning solutions, and disinfectants during visit. This clears 24hr correction* Licensee will retrain staff on this regulation and send proof of retraining via email by 12/5/2024.
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LPA's observed janitorial cart containing cleaning supplies, cleaning solutions, and disinfectants accessible to clients. Cleaning solutions were observed to be accessible to clients in laundry room.
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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:Tony Vasallo
LICENSING EVALUATOR NAME:Kimberly Ramirez
LICENSING EVALUATOR SIGNATURE:
DATE: 11/22/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/22/2024


LIC809 (FAS) - (06/04)
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