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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198603734
Report Date: 04/18/2024
Date Signed: 04/18/2024 04:21:02 PM

Document Has Been Signed on 04/18/2024 04:21 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:2ND CHOICEFACILITY NUMBER:
198603734
ADMINISTRATOR/
DIRECTOR:		WHITE, ANDREAFACILITY TYPE:
735
ADDRESS:1460 N TOWNE AVETELEPHONE:
(917) 676-9966
CITY:CLAREMONTSTATE: CAZIP CODE:
91711
CAPACITY: 6CENSUS: 0DATE:
04/18/2024
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:24 AM
MET WITH:House Manager Tonie PiperTIME VISIT/
INSPECTION COMPLETED:
10:30 AM
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Licensing Program Analyst (LPA) Kimberly Ramirez conducted an announced pre-licensing visit on 4/18/2024 and was met by Administrator Tonie Piper. The facility will be licensed as an Adult Residential facility to serve 4 ambulatory and 2 non-ambulatory consumers within the age of 18-59 years.

Observations:
Structure: Facility is a single-story home located in a residential area consisting of three (3) bedrooms, two (2) bathrooms, kitchen, dining room, living room, laundry area in attached garage, and backyard with outdoor covered patio. Front yard is landscaped with grass and back yard is landscaped. Bedroom Clients: Bedrooms are all shared. Bedroom#1 and 2 are designated ambulatory. Bedroom#3 is designated for non-amulatory.Bedrooms are equipped with one bed, nightstand, chair, lamp, and overhead lighting. Bathrooms: Two (2) full bathrooms equipped with working toilets, wash basins, bathtub/ walk-in shower. Bathroom#2 is located in shared bedroom#3. Linens & Hygiene Supplies: All beds had the required linen/supplies which include, pillowcase, mattress pads, fitted sheet, blanket and bedspreads. Adequate supply of linens is stored in linen closets. Emergency Phone Numbers, Exit Plan: Emergency numbers are posted and readily available for review. Two (2) fully charged fire extinguisher was observed. Facility has a land line telephone. Food Service: Dishes, cups, and flatware are stored in the kitchen cupboards, inspected and in good repair. Knives, cutlery, and other sharp kitchen utensils were observed locked and inaccessible. Adequate food supply is stored in the kitchen and consists of the following: 2-day perishables, and 7-day non-perishables. Emergency water supply was observed. Smoke Detectors: There are electrical & inter-connected smoke detectors located in all bedrooms, common areas, and hallways. Appliances: Refrigerator, oven, microwave, dishwasher and washer/dryer are in good condition. The residence is equipped with central heating and air conditioning. Toxins: Cleaning supplies, and toxins are locked only accessible to staff.

***Narrative continues next page.****

SUPERVISORS NAME: Tony Vasallo
LICENSING EVALUATOR NAME: Kimberly Ramirez
LICENSING EVALUATOR SIGNATURE: DATE: 04/18/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/18/2024
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 2
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: 2ND CHOICE
FACILITY NUMBER: 198603734
VISIT DATE: 04/18/2024
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Water Temperature: Hot water was tested in all bathrooms, and kitchen sink. Water temperature was within normal limits 105 degrees Fahrenheit (40.5 degrees C) and not more than 120 degrees Fahrenheit (48.8 degrees C). Medication, First-Aid Kit & Book: Designated centrally stored medications cabinet, and the first-aid kit has been inspected which has at least the following: tweezers, scissors, antiseptic, bandages, gauze, thermometer; including a current First Aid manual. Resident & Staff Files: Designated area for files will be in staff office area. Pools/Jacuzzi/Body of Water & Pets: No bodies of water were observed. Fire Clearance: Fire clearance was approved on 1/25/24 for 4 ambulatory and 2 non-ambulatory. Component III: Component III was reviewed with House Manager Tonie Piper.

No health and safety concerns were observed. Exit interview was conducted, and a copy of this report will be emailed to Licensee. Accordingly, LPA will submit a copy of this facility evaluation report to the Central Applications Bureau (CAB) for review. If the applicant has questions regarding the status of the application, they have been instructed to communicate with the CAB Analyst assigned to their application.
SUPERVISORS NAME: Tony Vasallo
LICENSING EVALUATOR NAME: Kimberly Ramirez
LICENSING EVALUATOR SIGNATURE:

DATE: 04/18/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/18/2024
LIC809 (FAS) - (06/04)
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