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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306004162
Report Date: 01/18/2024
Date Signed: 01/18/2024 05:00:28 PM

Document Has Been Signed on 01/18/2024 05:00 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
EL SEGUNDO ASC, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245
FACILITY NAME:DE LEON HOMESFACILITY NUMBER:
306004162
ADMINISTRATOR:APRIL GORMANFACILITY TYPE:
735
ADDRESS:6100 E. WALTON STREETTELEPHONE:
5623546195
CITY:LONG BEACHSTATE: CAZIP CODE:
90815
CAPACITY: 4CENSUS: 4DATE:
01/18/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:11 AM
MET WITH:April Gorman, AdministratorTIME COMPLETED:
05:12 PM
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On 01/18/2023 Licensing Program Analyst (LPA) Mario Leon conducted an unannounced annual inspection visit at the De Leon Homes Facility. LPA was allowed entry into the facility by staff member Sherl and was later met by Administrator, April Gorman. Administrator April Gorman and LPA toured the facility. The facility is licensed for four (4) adult clients with developmental disabilities. Currently, there are four (4) residents residing in the facility with developmental disabilities.
The facility is a one-story residential home, located in a residential neighborhood and it consists of four (4) resident bedrooms, two (2) resident bathrooms, living room, dining room, family room, kitchen, office area, attached garage with washer/dryer and storage area, backyard with table and chairs. No weapons are stored in the premises. Kitchen was inspected and observed to be clean and operational. A two-day (2) supply perishable and seven-day (7) supply of non-perishable foods are present in the facility. An emergency, 7-day water supply is found in the garage.
LPA observed that all facility rooms are clean and in good repair. A comfortable temperature was observed, and the facility has central air and heating. LPA observed the following during inspection of resident’s rooms: mattresses are in good condition, adequate lighting present, plenty of dresser/closet space is present, and all bed linens present. All bedrooms contain furniture, lighting fixtures and personal storage space as required, all beds have the required amount of linen and mattress covers, LPA observed a fully stocked closet with bedding, towels, and toiletry supplies. Bathroom fixtures are clean, in good repair, and working properly and contain the required nonskid mats and grab bars. LPA observed bathrooms were found to be within Title 22 regulation. Bathroom #1 hot water temperature properly measured at 119 degrees Fahrenheit, and bathroom #2 hot water temperature properly measured at 117 degrees Fahrenheit. Kitchen hot water temperature properly measured at 120 degrees Fahrenheit. Facility has one (1) Carbon Monoxide detector and seven (7) Smoke Detectors which are inter-connected. All detectors were tested and are in working condition. The facilities' two (2) Fire Extinguishers were checked and found to be fully charged and accessible, purchased 01/05/24. The facilities' last fire drill was conducted 01/02/2024.
Report continues, see LIC809C
SUPERVISORS NAME: Ulysses Coronel
LICENSING EVALUATOR NAME: Mario Leon
LICENSING EVALUATOR SIGNATURE: DATE: 01/18/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/18/2024
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
EL SEGUNDO ASC, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245
FACILITY NAME: DE LEON HOMES
FACILITY NUMBER: 306004162
VISIT DATE: 01/18/2024
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 All exit doors in the facility have alarm systems. All toxins and knifes are locked and inaccessible to residents. The rear screen door has a tear about 4" by 6" near the handle.
Medications are centrally stored and in a locked storage cabinet. Facility first aid kit is fully stocked with manual was checked and in order. Outside grounds were toured and no bodies of water were observed. All Exits/Walkways around the home were free of debris and hazards. Outside patio accessible to residents. Four (4) resident files were reviewed and all were found to be complete. LPA reviewed two (2) resident medications and they were all found to be administered according to doctor's orders. Two (2) staff files were checked and have the required documents. The facility does handle resident's money/cash resources and hold a Surety bond with Bryant Surety Company, policy #3404730, for $1000.00. Licensee produced a Professional Liability Insurance Policy, currently under audit, at time of inspection.

There has been one technical violation note provided, see LIC9102-AN (TV note).

An exit interview was held with April Gorman, Administrator, copy of this report has been provided along with the TV note.
SUPERVISORS NAME: Ulysses Coronel
LICENSING EVALUATOR NAME: Mario Leon
LICENSING EVALUATOR SIGNATURE:

DATE: 01/18/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/18/2024
LIC809 (FAS) - (06/04)
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